Provider Demographics
NPI:1700867793
Name:DENTEN, LUANN CARMODY (LPC)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:CARMODY
Last Name:DENTEN
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 1:531 CHAROAK DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6217
Mailing Address - Country:US
Mailing Address - Phone:636-527-3735
Mailing Address - Fax:636-527-3735
Practice Address - Street 1:531 CHAROAK DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-6217
Practice Address - Country:US
Practice Address - Phone:636-527-3735
Practice Address - Fax:636-527-3735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional