Provider Demographics
NPI:1710978457
Name:URBAN, DEBORAH LEE (LPC, NCC, EFT-ADV)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:URBAN
Suffix:
Gender:F
Credentials:LPC, NCC, EFT-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 26221
Mailing Address - Street 2:PINE CONE LANE
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-9662
Mailing Address - Country:US
Mailing Address - Phone:573-727-6428
Mailing Address - Fax:573-223-7363
Practice Address - Street 1:RR 2 BOX 26221
Practice Address - Street 2:PINE CONE LANE
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-9662
Practice Address - Country:US
Practice Address - Phone:573-727-6428
Practice Address - Fax:573-223-7363
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498570019Medicaid