Provider Demographics
NPI:1992519045
Name:GAVIRIA-DEQUE, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:GAVIRIA-DEQUE
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 1:3354 HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-7841
Mailing Address - Country:US
Mailing Address - Phone:620-331-1748
Mailing Address - Fax:
Practice Address - Street 1:3354 HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-7841
Practice Address - Country:US
Practice Address - Phone:620-331-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional