Provider Demographics
NPI:1578944559
Name:DEDEAUX, ROYA (MS, MFT INTERN)
Entity Type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:DEDEAUX
Suffix:
Gender:F
Credentials:MS, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 KATELLA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2828
Mailing Address - Country:US
Mailing Address - Phone:562-480-6369
Mailing Address - Fax:
Practice Address - Street 1:5212 KATELLA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2828
Practice Address - Country:US
Practice Address - Phone:562-480-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 73122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist