Provider Demographics
NPI:1275232084
Name:MOTHERSHED, DEKEYDRA DENIESHA NICOLE
Entity Type:Individual
Prefix:
First Name:DEKEYDRA
Middle Name:DENIESHA NICOLE
Last Name:MOTHERSHED
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 1:4083 N PEACH AVE APT 267
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-8410
Mailing Address - Country:US
Mailing Address - Phone:559-217-0965
Mailing Address - Fax:
Practice Address - Street 1:2291 N HAZEL AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-5562
Practice Address - Country:US
Practice Address - Phone:559-492-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor