Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301013463 | MI |
NPI | 1124366950 |
---|---|
Provider Name | Dr. Craig Allen Derror |
First Address | Cadillac, MI 49601-8126 |
Second Address | Cadillac, MI 49601-8126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2013 |
Last Update Date | 29/01/2013 |