Healthcare Provider Details

I. General information

NPI: 1114565405
Provider Name (Legal Business Name): DENNIS DEMILLE MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W BOONE AVE STE 380
SPOKANE WA
99201-2346
US

IV. Provider business mailing address

316 W BOONE AVE STE 380
SPOKANE WA
99201-2346
US

V. Phone/Fax

Practice location:
  • Phone: 509-903-8606
  • Fax:
Mailing address:
  • Phone: 509-903-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61530145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: