Active NPI
Andre Deshong, LCDC
- Addiction (Substance Use Disorder) Counselor
- Tyler, TX
National Provider Identifier
1467683078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 10930
- Practice address
- 3800 Paluxy Dr Ste 405
Tyler, TX 75703-1662 - Phone
- (903) 253-6531
- Fax
- (903) 565-6087
- NPI assigned
- Jul 30, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 10930 | TX | Primary |
Addresses
Primary practice location
3800 Paluxy Dr Ste 405
Tyler, TX 75703-1662
Mailing address
3800 Paluxy Dr Ste 405
Tyler, TX 75703-1662
Phone (903) 253-6531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10930 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678752000000",
"number": "1467683078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 PALUXY DR STE 405",
"city": "TYLER",
"state": "TX",
"postal_code": "757031662",
"telephone_number": "903-253-6531",
"fax_number": "903-535-7386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 PALUXY DR STE 405",
"city": "TYLER",
"state": "TX",
"postal_code": "757031662",
"telephone_number": "903-253-6531",
"fax_number": "903-565-6087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESHONG",
"first_name": "ANDRE",
"credential": "LCDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-30",
"last_updated": "2023-03-14",
"certification_date": "2023-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "10930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.