Provider Demographics
NPI:1619255684
Name:DEBORD, KURT ALLEN
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALLEN
Last Name:DEBORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 W STEWART RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2203
Mailing Address - Country:US
Mailing Address - Phone:573-881-5878
Mailing Address - Fax:
Practice Address - Street 1:1005 CHERRY ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7900
Practice Address - Country:US
Practice Address - Phone:573-881-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024724103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist