Provider Demographics
NPI:1275925661
Name:SPENCER, DEANA M (LH60695140)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LH60695140
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11651 WESTSIDE CALISPELL RD
Mailing Address - Street 2:
Mailing Address - City:USK
Mailing Address - State:WA
Mailing Address - Zip Code:99180-9764
Mailing Address - Country:US
Mailing Address - Phone:509-447-7402
Mailing Address - Fax:
Practice Address - Street 1:15714 E VALLEYWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9583
Practice Address - Country:US
Practice Address - Phone:509-671-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60695140101YM0800X
WACO60452219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)