Provider Demographics
NPI:1457033938
Name:DEEDS, CHEYENNE MARIE
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:MARIE
Last Name:DEEDS
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 1:2009 TUMBER WAY
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-5186
Mailing Address - Country:US
Mailing Address - Phone:530-315-1551
Mailing Address - Fax:
Practice Address - Street 1:874 PLUMAS ST STE C
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4023
Practice Address - Country:US
Practice Address - Phone:530-443-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2340041106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician