Provider Demographics
NPI:1558505099
Name:DUVALL, ROSALIE MARIE (LPC, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:MARIE
Last Name:DUVALL
Suffix:
Gender:F
Credentials:LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 MANCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4423
Mailing Address - Country:US
Mailing Address - Phone:314-853-8218
Mailing Address - Fax:
Practice Address - Street 1:12015 MANCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4423
Practice Address - Country:US
Practice Address - Phone:314-853-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
M04036OtherMUSIC THERAPIST, BOARD CERTIFIES
MO002791OtherLICENSED PROFESSIONAL COUNSELOR