Healthcare Provider Details

I. General information

NPI: 1407900947
Provider Name (Legal Business Name): CHRISTIAN JOSE DEAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BRAKLEY DR SUITE B2
BATON ROUGE LA
70816-2333
US

IV. Provider business mailing address

2924 BRAKLEY DR STE B2
BATON ROUGE LA
70816-2333
US

V. Phone/Fax

Practice location:
  • Phone: 225-205-7508
  • Fax: 225-214-0068
Mailing address:
  • Phone: 225-205-7508
  • Fax: 225-214-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2772
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number691
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: