Provider Demographics
NPI:1598035354
Name:DUECKER, CANDIS DIANE (MS ED, LPC)
Entity Type:Individual
Prefix:
First Name:CANDIS
Middle Name:DIANE
Last Name:DUECKER
Suffix:
Gender:F
Credentials:MS ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 TODD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-9356
Mailing Address - Country:US
Mailing Address - Phone:816-431-6458
Mailing Address - Fax:
Practice Address - Street 1:1716 TODD ST
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9356
Practice Address - Country:US
Practice Address - Phone:816-431-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional