Provider Demographics
NPI:1598705238
Name:DEIFE, DEE (BA)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:DEIFE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 564
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:WA
Mailing Address - Zip Code:99159
Mailing Address - Country:US
Mailing Address - Phone:509-633-1471
Mailing Address - Fax:509-633-2148
Practice Address - Street 1:322 FORTUYN RD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133
Practice Address - Country:US
Practice Address - Phone:509-633-1471
Practice Address - Fax:509-633-2148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00031396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health