Bill Ray Deatherage, PSY.D., MFTI

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S0993236 Issued in CA

Practice address

405 W 5TH St
Suite 590
Santa Ana, CA 92701-4519

Phone

(714) 834-5015

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497762660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23446 VIA JACINTO",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926561162",
            "telephone_number": "949-586-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W 5TH ST",
            "address_2": "SUITE 590",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927014519",
            "telephone_number": "714-834-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "BILL",
        "middle_name": "RAY",
        "credential": "PSY.D., MFTI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "S0993236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca De Ruyter, P.T.
• Nathalie Marie De Vera, PA-C
• Daisy Dean
• Tina Dean, AA IN HUMAN SERVICES
• Olga Deaquino
• Christina Deckert, M.D.
• Nicole Alexandra Defelicis
• Marissa Marie Degeorge
• Jeannette Degrave
• Rhian Edward Deguzman, PA-C

• Mental Health Counselor in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.