Individual
BILL RAY DEATHERAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D., MFTI
Contact information
Practice address
405 W 5TH ST, SUITE 590, SANTA ANA, CA 92701-4519
(714) 834-5015
Mailing address
23446 VIA JACINTO, ALISO VIEJO, CA 92656-1162
(949) 586-4634
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
S0993236
CA
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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