Basic Information
| Provider Information | |||||||||
| NPI: | 1043505829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEATON | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41945 BIG BEAR BLVD STE 222 | ||||||||
| Address2: | |||||||||
| City: | BIG BEAR LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923152030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098665070 | ||||||||
| FaxNumber: | 9098783228 | ||||||||
| Practice Location | |||||||||
| Address1: | 41945 BIG BEAR BLVD STE 222 | ||||||||
| Address2: | |||||||||
| City: | BIG BEAR LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923152030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098665070 | ||||||||
| FaxNumber: | 9098783228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF71703 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT96976 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.