Provider Demographics
NPI:1457606725
Name:DEVORE, HELEN COLLEEN
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:COLLEEN
Last Name:DEVORE
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 1:1862 TOWNE PARK DR
Mailing Address - Street 2:APT. 3A
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8336
Mailing Address - Country:US
Mailing Address - Phone:937-344-8455
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1983
Practice Address - Country:US
Practice Address - Phone:937-534-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900660-CR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health