Healthcare Provider Details

I. General information

NPI: 1659645984
Provider Name (Legal Business Name): CANDACE LAUREN DEESE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35210 AVENUE A
YUCAIPA CA
92399-4325
US

IV. Provider business mailing address

35210 AVENUE A
YUCAIPA CA
92399-4325
US

V. Phone/Fax

Practice location:
  • Phone: 909-372-0683
  • Fax: 909-253-0199
Mailing address:
  • Phone: 909-372-0683
  • Fax: 909-253-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number86869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: