Healthcare Provider Details

I. General information

NPI: 1265707723
Provider Name (Legal Business Name): SUSAN ARBO-DEROUCHEY MS LPC CRADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 02/14/2024
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 NW W HWY
KINGSVILLE MO
64061-9117
US

IV. Provider business mailing address

441 NW W HWY
KINGSVILLE MO
64061-9117
US

V. Phone/Fax

Practice location:
  • Phone: 816-308-0246
  • Fax: 816-566-0486
Mailing address:
  • Phone: 816-308-0246
  • Fax: 816-566-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5652
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2012007309
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: