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General NPI Number Information
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NPI Number | 1518074657
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Entity Type | Individual
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Provider Name | PENELOPE KARLA DURBAN LPC
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14323 SOUTH OUTER 40 SUITE 607 SOUTH
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-275-2500
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Fax | 314-275-7773
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Provider Business Mailing Address
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Address Line | 14323 SOUTH OUTER 40 SUITE 607 SOUTH
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-275-2500
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Fax | 314-275-7773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CS000045
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License Number State | MO
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