Provider Demographics
NPI:1659645984
Name:DEESE, CANDACE LAUREN (MS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LAUREN
Last Name:DEESE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1648
Mailing Address - Country:US
Mailing Address - Phone:513-334-5899
Mailing Address - Fax:909-253-0199
Practice Address - Street 1:1096 CALIMESA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1563
Practice Address - Country:US
Practice Address - Phone:909-372-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA86869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health