Provider Demographics
NPI:1356649073
Name:DUMONT, DEBORAH LYNN (CTRS)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:DUMONT
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:BECKMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:1520 KELLY PLACE, 2ND FLOOR
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0329
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:509-524-2993
Practice Address - Street 1:1520 KELLEY PL FL 2
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:509-524-2993
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60128428101YM0800X
WARE00000300225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist