Provider Demographics
NPI:1982364568
Name:DEJONG, JEREMY GENE (BHT)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:GENE
Last Name:DEJONG
Suffix:
Gender:M
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5338
Mailing Address - Country:US
Mailing Address - Phone:602-274-4343
Mailing Address - Fax:
Practice Address - Street 1:4343 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5338
Practice Address - Country:US
Practice Address - Phone:602-274-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician