Provider Demographics
NPI:1720181340
Name:DYSON, EVE T (LPC)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:T
Last Name:DYSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:T
Other - Last Name:KAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:8240 ST CHARLES ROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114
Mailing Address - Country:US
Mailing Address - Phone:314-427-3755
Mailing Address - Fax:314-426-0764
Practice Address - Street 1:8240 ST CHARLES ROCK ROAD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114
Practice Address - Country:US
Practice Address - Phone:314-427-3755
Practice Address - Fax:314-426-0764
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional