Provider Demographics
NPI:1922432095
Name:DEVILLEZ, JAMIE ESTELLA
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ESTELLA
Last Name:DEVILLEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10176 CORPORATE SQUARE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2924
Mailing Address - Country:US
Mailing Address - Phone:314-605-7743
Mailing Address - Fax:
Practice Address - Street 1:10176 CORPORATE SQUARE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2924
Practice Address - Country:US
Practice Address - Phone:314-605-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013031452103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst