Healthcare Provider Details

I. General information

NPI: 1932506755
Provider Name (Legal Business Name): DEVEREUX CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 FALBERG WAY
GOLETA CA
93117
US

IV. Provider business mailing address

PO BOX 6784
SANTA BARBARA CA
93160-6784
US

V. Phone/Fax

Practice location:
  • Phone: 805-968-2525
  • Fax: 805-968-3247
Mailing address:
  • Phone: 805-968-2525
  • Fax: 805-968-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY M EVANS
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LMFT,
Phone: 805-968-2525