Provider Demographics
NPI:1639582455
Name:DEVEREUX, STEPHANIE A (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:DEVEREUX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PENSACOLA CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6689
Mailing Address - Country:US
Mailing Address - Phone:636-219-6678
Mailing Address - Fax:
Practice Address - Street 1:2536 S OLD HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5612
Practice Address - Country:US
Practice Address - Phone:636-219-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014000733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional