Provider Demographics
NPI:1720438658
Name:DEAL, DAMON (MHS)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:DEAL
Suffix:
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W GENIE ST
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2130
Mailing Address - Country:US
Mailing Address - Phone:504-272-4082
Mailing Address - Fax:
Practice Address - Street 1:430 W GENIE ST
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-2130
Practice Address - Country:US
Practice Address - Phone:504-272-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health