Provider Demographics
NPI:1902003114
Name:DICKENS, DENISE ELAINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELAINE
Last Name:DICKENS
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 1:125 S MAIN ST
Mailing Address - Street 2:PO BOX 178
Mailing Address - City:LIBERAL
Mailing Address - State:MO
Mailing Address - Zip Code:64762-0178
Mailing Address - Country:US
Mailing Address - Phone:417-843-2082
Mailing Address - Fax:
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:MO
Practice Address - Zip Code:64762-9313
Practice Address - Country:US
Practice Address - Phone:417-843-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional