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General NPI Number Information
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NPI Number | 1962916254
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Entity Type | Individual
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Provider Name | CHAITRA ELISE DEVEREAUX PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 22530 SE 64TH PL STE 220
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City | ISSAQUAH
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State | WA
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Zip | 98027-5353
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Country | US
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Telephone | 425-677-8686
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Fax | 425-961-0783
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Provider Business Mailing Address
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Address Line | 12904 126TH CT NE APT J104
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City | KIRKLAND
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State | WA
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Zip | 98034-3274
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Country | US
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Telephone | 425-287-7753
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MC60535134
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License Number State | WA
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