Basic Information
| Provider Information | |||||||||
| NPI: | 1003140898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBEUS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 S PACK SQ STE 350 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283335359 | ||||||||
| FaxNumber: | 8283335359 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 S PACK SQ STE 350 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283335359 | ||||||||
| FaxNumber: | 8283335359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2009 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 3841 | NC | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | 3841 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 6001185 | 05 | NC | MEDICAID |