Healthcare Provider Details

I. General information

NPI: 1083572267
Provider Name (Legal Business Name): MR. JOSEPH MICHAEL DESTAVEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14819 E MISSION AVE
SPOKANE VALLEY WA
99216-1960
US

IV. Provider business mailing address

11901 E 6TH AVE
SPOKANE VALLEY WA
99206-2806
US

V. Phone/Fax

Practice location:
  • Phone: 509-915-9791
  • Fax: 509-474-9612
Mailing address:
  • Phone: 850-428-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDPT.CO.70096595
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: