Provider Demographics
NPI:1841973294
Name:XAN C DEVANEY
Entity type:Organization
Organization Name:XAN C DEVANEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:XAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:707-616-9649
Mailing Address - Street 1:PO BOX 6691
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:922 E ST STE 202
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1873
Practice Address - Country:US
Practice Address - Phone:707-616-9649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health