Provider Demographics
NPI:1740526854
Name:CHAVEZ, DESHON RENEE
Entity type:Individual
Prefix:
First Name:DESHON
Middle Name:RENEE
Last Name:CHAVEZ
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 1:1125 E CLARK AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5192
Mailing Address - Country:US
Mailing Address - Phone:805-739-1512
Mailing Address - Fax:805-739-2855
Practice Address - Street 1:1125 E CLARK AVE STE A2
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5192
Practice Address - Country:US
Practice Address - Phone:805-739-1512
Practice Address - Fax:805-739-2855
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)