Provider Demographics
NPI:1821227703
Name:CANTER-MORTON, DEVRA ANNE (DEVRA)
Entity Type:Individual
Prefix:
First Name:DEVRA
Middle Name:ANNE
Last Name:CANTER-MORTON
Suffix:
Gender:F
Credentials:DEVRA
Other - Prefix:
Other - First Name:DEVRA
Other - Middle Name:ANNE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DEVRA
Mailing Address - Street 1:PO BOX 4487
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4487
Mailing Address - Country:US
Mailing Address - Phone:512-469-9447
Mailing Address - Fax:
Practice Address - Street 1:314 E HIGHLAND MALL BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3735
Practice Address - Country:US
Practice Address - Phone:512-469-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist