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General NPI Number Information
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NPI Number | 1467683078
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Entity Type | Individual
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Provider Name | ANDRE DESHONG LCDC
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Gender | Male
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 3800 PALUXY DR STE 405
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City | TYLER
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State | TX
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Zip | 75703-1662
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Country | US
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Telephone | 903-253-6531
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Fax | 903-565-6087
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Provider Business Mailing Address
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Address Line | 3800 PALUXY DR STE 405
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City | TYLER
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State | TX
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Zip | 75703-1662
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Country | US
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Telephone | 903-253-6531
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Fax | 903-535-7386
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10930
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License Number State | TX
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