Healthcare Provider Details

I. General information

NPI: 1306191796
Provider Name (Legal Business Name): LAUREN DEIBEL QUEEN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 05/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 TESSON FERRY RD SUITE 203
SAINT LOUIS MO
63123-6966
US

IV. Provider business mailing address

436 HARVEST HILL CT
BALLWIN MO
63021-6269
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-2120
  • Fax: 314-729-1953
Mailing address:
  • Phone: 314-910-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008879
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010015161
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: