Provider Demographics
NPI:1407900947
Name:DEAN, CHRISTIAN JOSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:JOSE
Last Name:DEAN
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 1:12533 PARKMEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6703
Mailing Address - Country:US
Mailing Address - Phone:225-752-3823
Mailing Address - Fax:
Practice Address - Street 1:2924 BRAKLEY DR
Practice Address - Street 2:SUITE B2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2333
Practice Address - Country:US
Practice Address - Phone:225-205-7508
Practice Address - Fax:225-214-0068
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2772101YP2500X
LA691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist