Healthcare Provider Details

I. General information

NPI: 1629726047
Provider Name (Legal Business Name): DEBORAH B DOLL LPC, CCTP, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBBIE HARRIS

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5896 OSAGE BEACH PKWY STE 3
OSAGE BEACH MO
65065-3011
US

IV. Provider business mailing address

6665 EL TERRA RD
OSAGE BEACH MO
65065-3466
US

V. Phone/Fax

Practice location:
  • Phone: 573-723-1831
  • Fax: 573-562-6121
Mailing address:
  • Phone: 573-723-1831
  • Fax: 573-562-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020036321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: