Provider Demographics
NPI:1992536460
Name:TODMANN, DEZARAE NATASHA
Entity type:Individual
Prefix:
First Name:DEZARAE
Middle Name:NATASHA
Last Name:TODMANN
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 1:2922 MARBURG ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-4323
Mailing Address - Country:US
Mailing Address - Phone:469-354-3248
Mailing Address - Fax:
Practice Address - Street 1:2922 MARBURG ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-4323
Practice Address - Country:US
Practice Address - Phone:469-354-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health