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General NPI Number Information
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NPI Number | 1841973294
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Entity Type | Organization
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Legal Business Name | XAN C DEVANEY
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 922 E ST STE 202
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City | EUREKA
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State | CA
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Zip | 95501-1873
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Country | US
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Telephone | 707-616-9649
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6691
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City | EUREKA
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State | CA
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Zip | 95502-6691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | XAN DEVANEY
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Credential | PSY.D.
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Telephone | 707-616-9649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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