Donovan Dettle

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

530 Soquel Ave
Santa Cruz, CA 95062-2301

Phone

(831) 426-7322

NPI assigned

Oct 28, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Parents Center, Inc.

  • Community/Behavioral Health Agency
  • Freedom, CA
  • NPI 1881717981
  NPD
• Parents Center

  • Community/Behavioral Health Agency
  • Santa Cruz, CA
  • NPI 1083737167
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1346957461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 214",
            "city": "APTOS",
            "state": "CA",
            "postal_code": "950010214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 SOQUEL AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622301",
            "telephone_number": "831-426-7322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Green Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Freedom",
            "state": "CA",
            "postal_code": "950193112",
            "country_code": "US",
            "telephone_number": "831-426-7322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETTLE",
        "first_name": "DONOVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Desimone, D.O.
• Laura Michelle Destro
• Aaron Michael Desuacido, MA
• Darin Deterra, PHD
• Caitlin Elise Taylor Detter
• Julian Dewees
• Antonella Dewell, MS, RDN
• Dewitt Physical Therapy, Inc.
• Ryan Dewitt, P.T.
• Travis Lee Deyoung

• All providers in Santa Cruz, CA
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.