Provider Demographics
NPI:1992958441
Name:TEVIS, DAYNA L (MS)
Entity type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:L
Last Name:TEVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12598 CENTRAL AVE
Mailing Address - Street 2:205
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3502
Mailing Address - Country:US
Mailing Address - Phone:909-228-0302
Mailing Address - Fax:909-591-5094
Practice Address - Street 1:12598 CENTRAL AVE
Practice Address - Street 2:205
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3530
Practice Address - Country:US
Practice Address - Phone:909-228-0302
Practice Address - Fax:909-591-5094
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45292OtherLICENSE #