Provider Demographics
NPI:1134363203
Name:DEAS, ISAAC BENJAMIN II (LMHC)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:BENJAMIN
Last Name:DEAS
Suffix:II
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3270
Mailing Address - Country:US
Mailing Address - Phone:352-406-1264
Mailing Address - Fax:352-343-6115
Practice Address - Street 1:385 W ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3270
Practice Address - Country:US
Practice Address - Phone:352-406-1264
Practice Address - Fax:352-343-6115
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7321172V00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health