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General NPI Number Information
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NPI Number | 1083572267
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Entity Type | Individual
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Provider Name | MR. JOSEPH MICHAEL DESTAVEN JR.
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Gender | Male
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 14819 E MISSION AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-1960
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Country | US
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Telephone | 509-915-9791
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Fax | 509-474-9612
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Provider Business Mailing Address
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Address Line | 11901 E 6TH AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-2806
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Country | US
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Telephone | 850-428-3643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | WA
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