Provider Demographics
NPI:1861882037
Name:COUSINS, DEENA S (LPC)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:S
Last Name:COUSINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CRABAPPLE CT
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3416
Mailing Address - Country:US
Mailing Address - Phone:314-323-7788
Mailing Address - Fax:
Practice Address - Street 1:2645 W CLAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2525
Practice Address - Country:US
Practice Address - Phone:314-323-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013006131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional