Provider Demographics
NPI:1063802064
Name:DEVEITEO, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DEVEITEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 NORTHWEST AVE
Mailing Address - Street 2:#35
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1270
Mailing Address - Country:US
Mailing Address - Phone:360-510-8665
Mailing Address - Fax:
Practice Address - Street 1:3422 NORTHWEST AVE
Practice Address - Street 2:#35
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1270
Practice Address - Country:US
Practice Address - Phone:360-510-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP60177878103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603043322OtherUNIFORM BUSINESS IDENTIFIER (UBI)