Provider Demographics
NPI:1972146108
Name:DESHETLER, COURTNEY SHEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:SHEN
Last Name:DESHETLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANNE
Other - Last Name:SHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3419 E CHAPMAN AVE # 354
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7712
Practice Address - Country:US
Practice Address - Phone:714-462-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2024-06-03
Deactivation Date:2019-10-22
Deactivation Code:
Reactivation Date:2022-02-23
Provider Licenses
StateLicense IDTaxonomies
CA31253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical