Provider Demographics
NPI:1568761823
Name:ANTHONY, DEBRA MICHELLE (MA PROFESS COUNSELIN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MICHELLE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MA PROFESS COUNSELIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2953 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1501
Mailing Address - Country:US
Mailing Address - Phone:314-910-0452
Mailing Address - Fax:314-776-5091
Practice Address - Street 1:16460 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1132
Practice Address - Country:US
Practice Address - Phone:314-910-0452
Practice Address - Fax:314-776-5124
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO101Y00000X
MO0476158101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor