Provider Demographics
NPI:1821563040
Name:PARISH, DEANNA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MICHELLE
Last Name:PARISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:UT
Mailing Address - Zip Code:84071-0198
Mailing Address - Country:US
Mailing Address - Phone:435-268-9897
Mailing Address - Fax:
Practice Address - Street 1:272 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2244
Practice Address - Country:US
Practice Address - Phone:435-268-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18-64031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician