Provider Demographics
NPI:1962916254
Name:DEVEREAUX, CHAITRA ELISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHAITRA
Middle Name:ELISE
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12904 126TH CT NE APT J104
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3274
Mailing Address - Country:US
Mailing Address - Phone:425-287-7753
Mailing Address - Fax:
Practice Address - Street 1:22530 SE 64TH PL STE 220
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5353
Practice Address - Country:US
Practice Address - Phone:425-677-8686
Practice Address - Fax:425-961-0783
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60535134103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling