Provider Demographics
NPI:1174065494
Name:HUGHES, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8963 OPAL CANYON CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9290
Mailing Address - Country:US
Mailing Address - Phone:916-442-2396
Mailing Address - Fax:916-442-2525
Practice Address - Street 1:8963 OPAL CANYON CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9290
Practice Address - Country:US
Practice Address - Phone:916-442-2396
Practice Address - Fax:916-442-2525
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician