Provider Demographics
NPI:1457586372
Name:BEAN, EVETTE DEJON (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:DEJON
Last Name:BEAN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 ESTRADA DR
Mailing Address - Street 2:APT 11
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2274
Mailing Address - Country:US
Mailing Address - Phone:314-691-7738
Mailing Address - Fax:
Practice Address - Street 1:1524 ESTRADA DR
Practice Address - Street 2:APT 11
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2274
Practice Address - Country:US
Practice Address - Phone:314-691-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008037622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional