Provider Demographics
NPI:1730689472
Name:HERRERA-THOMAS, DEANNA GUIDE (EDD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:GUIDE
Last Name:HERRERA-THOMAS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-1064
Mailing Address - Country:US
Mailing Address - Phone:707-499-3739
Mailing Address - Fax:
Practice Address - Street 1:107 SMITH ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2637
Practice Address - Country:US
Practice Address - Phone:707-499-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-29397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical