Provider Demographics
NPI:1467683078
Name:DESHONG, ANDRE (LCDC)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:DESHONG
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PALUXY DR STE 405
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1662
Mailing Address - Country:US
Mailing Address - Phone:903-253-6531
Mailing Address - Fax:903-535-7386
Practice Address - Street 1:3800 PALUXY DR STE 405
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1662
Practice Address - Country:US
Practice Address - Phone:903-253-6531
Practice Address - Fax:903-565-6087
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10930101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)