Active NPI
Penelope Karla Durban, LPC
- Mental Health Counselor
- Chesterfield, MO
National Provider Identifier
1518074657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CS000045
- Practice address
- 14323 South Outer 40
Suite 607 South
Chesterfield, MO 63017 - Phone
- (314) 275-2500
- Fax
- (314) 275-7773
- NPI assigned
- Aug 24, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CS000045 | MO | Primary |
Addresses
Primary practice location
14323 South Outer 40
Suite 607 South
Chesterfield, MO 63017
Mailing address
14323 South Outer 40
Suite 607 South
Chesterfield, MO 63017
Phone (314) 275-2500
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0004212729 | Other | AETNA | |
| 212591 | Other | HEALTHLINK | |
| 39171 | Other | GHP CMR | |
| IP289560 | Other | MAGELLAN | |
| 11257320 | Other | CAQH | |
| 113652 | Other | MO | BLUE CROSS |
| 120767 | Other | COMPSYCH | |
| 215041 | Other | PHCS | |
| 6269110 | Other | UBH | |
| 021679 | Other | VMC BEHAVIORAL | |
| 007981 | Other | VENDOR ID | |
| 100167 | Other | MANAGED HEALTH NETWORK | |
| 1071212 | Other | CIGNA | |
| 147764 | Other | VALUE OPTION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CS000045 | MO | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paul H Wang M Div PH D & Associates P C | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1952684995
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1518074657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14323 SOUTH OUTER 40",
"address_2": "SUITE 607 SOUTH",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "63017",
"telephone_number": "314-275-2500",
"fax_number": "314-275-7773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14323 SOUTH OUTER 40",
"address_2": "SUITE 607 SOUTH",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "63017",
"telephone_number": "314-275-2500",
"fax_number": "314-275-7773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURBAN",
"first_name": "PENELOPE",
"middle_name": "KARLA",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "CS000045",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0004212729",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "212591",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP CMR",
"identifier": "39171",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "IP289560",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11257320",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "113652",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMPSYCH",
"identifier": "120767",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "215041",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "6269110",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VMC BEHAVIORAL",
"identifier": "021679",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VENDOR ID",
"identifier": "007981",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "100167",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1071212",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTION",
"identifier": "147764",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesterfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.