Provider Demographics
NPI:1649347329
Name:EARLY, DEBRA JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEAN
Last Name:EARLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:SINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6220 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7839
Mailing Address - Country:US
Mailing Address - Phone:314-894-2900
Mailing Address - Fax:314-894-2960
Practice Address - Street 1:6220 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7839
Practice Address - Country:US
Practice Address - Phone:314-894-2900
Practice Address - Fax:314-894-2960
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006028096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical