Basic Information
Provider Information
NPI: 1003140898
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEBEUS
FirstName: MARY
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103G00000X3841NCN Behavioral Health & Social Service ProvidersClinical Neuropsychologist 
103T00000X3841NCY Behavioral Health & Social Service ProvidersPsychologist 

ID Information
IDTypeStateIssuerDescription
600118505NC MEDICAID


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