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General NPI Number Information
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NPI Number | 1235621889
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Entity Type | Individual
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Provider Name | MS. DEVA M CONNETT
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 3205 OCEAN PARK BLVD STE 240
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City | SANTA MONICA
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State | CA
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Zip | 90405-3234
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Country | US
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Telephone | 323-364-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 S FIGUEROA ST APT 114
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City | LOS ANGELES
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State | CA
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Zip | 90015-2802
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Country | US
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Telephone | 140-277-0416
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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 | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | BC-DMT-1164
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC-4657
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License Number State | CA
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