Provider Demographics
NPI:1205165313
Name:DEVENEZIA, JIM (MA)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:DEVENEZIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14921 W CAMDON DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85194-7207
Mailing Address - Country:US
Mailing Address - Phone:520-307-1203
Mailing Address - Fax:
Practice Address - Street 1:14921 W CAMDON DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-7207
Practice Address - Country:US
Practice Address - Phone:520-307-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health