Provider Demographics
NPI:1629276100
Name:DEMETER, DEBORA ANN (MA LPC)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:ANN
Last Name:DEMETER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E SEA AVENUE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-4536
Mailing Address - Country:US
Mailing Address - Phone:816-691-2944
Mailing Address - Fax:816-421-3162
Practice Address - Street 1:206 E SEA AVENUE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-4536
Practice Address - Country:US
Practice Address - Phone:816-691-2944
Practice Address - Fax:816-421-3162
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2000175374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional