Provider Demographics
NPI:1821652025
Name:DEVANEY, DANIEL MARTIN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARTIN
Last Name:DEVANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4024
Mailing Address - Country:US
Mailing Address - Phone:541-848-8304
Mailing Address - Fax:
Practice Address - Street 1:134 SE 5TH AVE STE C
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4095
Practice Address - Country:US
Practice Address - Phone:971-777-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)