Provider Demographics
NPI:1528380581
Name:DELANEY, DEIDRE (LPC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:DELANEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5736
Mailing Address - Country:US
Mailing Address - Phone:573-471-0800
Mailing Address - Fax:573-471-0810
Practice Address - Street 1:760 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5736
Practice Address - Country:US
Practice Address - Phone:573-471-0800
Practice Address - Fax:573-471-0810
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002031925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499264406Medicaid