Healthcare Provider Details

I. General information

NPI: 1508200767
Provider Name (Legal Business Name): GREGORY L DENEAL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 02/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 WATSON RD SUITE 335
SAINT LOUIS MO
63119-5329
US

IV. Provider business mailing address

264 MAPLE DR
FENTON MO
63026-3224
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006017537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: