Brandon Allen Dehaven
Individual provider Active NPI Counselor · Bishop, CA
NPI 1821781808 · NPPES record last updated May 26, 2023
Key facts
- NPI
- 1821781808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 1360 N Main St
Bishop, CA 93514-3013 - Phone
- (760) 872-2590
- NPI assigned
- May 26, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
1360 N Main St
Bishop, CA 93514-3013
Mailing address
1360 N Main St
Bishop, CA 93514-3013
Phone (760) 872-2590
Other providers in Bishop, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.