Provider Demographics
NPI:1053566364
Name:DESCOTEAUX, DONNA RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RUTH
Last Name:DESCOTEAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 MAIN ST.
Mailing Address - Street 2:P.O. BOX 684
Mailing Address - City:SAN LUIS
Mailing Address - State:CO
Mailing Address - Zip Code:81152-0684
Mailing Address - Country:US
Mailing Address - Phone:719-672-3143
Mailing Address - Fax:
Practice Address - Street 1:815 A MAIN ST.
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:CO
Practice Address - Zip Code:81152-0684
Practice Address - Country:US
Practice Address - Phone:719-672-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical