Provider Demographics
NPI:1932395449
Name:DEVERE, KELLY C (PLPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:DEVERE
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 1:15593 BEDFORD FORGE DR
Mailing Address - Street 2:UNIT #21
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4955
Mailing Address - Country:US
Mailing Address - Phone:314-267-5594
Mailing Address - Fax:
Practice Address - Street 1:15593 BEDFORD FORGE DR
Practice Address - Street 2:UNIT #21
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4955
Practice Address - Country:US
Practice Address - Phone:314-267-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015598101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor