Provider Demographics
NPI:1801028949
Name:DEAN, GRACE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-0742
Mailing Address - Country:US
Mailing Address - Phone:636-896-6826
Mailing Address - Fax:
Practice Address - Street 1:58 PORTWEST CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5985
Practice Address - Country:US
Practice Address - Phone:636-916-5800
Practice Address - Fax:636-916-0146
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24372103T00000X
MO2012041100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist