Healthcare Provider Details

I. General information

NPI: 1821136532
Provider Name (Legal Business Name): DEBORA KAY RUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date: 09/24/2014
Reactivation Date: 09/07/2022

III. Provider practice location address

1400 VICKSBURG DR
BELLEVILLE IL
62221-5760
US

IV. Provider business mailing address

PO BOX 732
O FALLON IL
62269-0732
US

V. Phone/Fax

Practice location:
  • Phone: 618-567-0925
  • Fax:
Mailing address:
  • Phone: 618-567-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.019516
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.019516
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019516
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: