Provider Demographics
NPI:1821668864
Name:STEPHANIE DEVEREUX LPC LLC
Entity Type:Organization
Organization Name:STEPHANIE DEVEREUX LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVEREUX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-219-6678
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:636-947-3155
Practice Address - Street 1:2536 S OLD HIGHWAY 94 STE 234
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:636-352-2947
Practice Address - Fax:636-947-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty