Provider Demographics
NPI:1033000252
Name:MUMTAZ, DURRE S (LPC)
Entity type:Individual
Prefix:MRS
First Name:DURRE
Middle Name:S
Last Name:MUMTAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DURRE
Other - Middle Name:SHAHWAR
Other - Last Name:MUMTAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1214 DEVONWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8447
Mailing Address - Country:US
Mailing Address - Phone:314-753-3153
Mailing Address - Fax:
Practice Address - Street 1:1214 DEVONWORTH DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8447
Practice Address - Country:US
Practice Address - Phone:314-753-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025027013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional