Provider Demographics
NPI:1144768318
Name:DEKOVEN, STANLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:DEKOVEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 D ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-3924
Mailing Address - Country:US
Mailing Address - Phone:760-580-7756
Mailing Address - Fax:
Practice Address - Street 1:1115 D ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-3924
Practice Address - Country:US
Practice Address - Phone:760-580-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 14570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist