Deanna Derry Counseling Llc | |
4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 | |
(260) 422-9372 | |
(260) 422-0843 |
Full Name | Deanna Derry Counseling Llc |
---|---|
Speciality | Social Worker |
Location | 4656 W Jefferson Blvd Ste 285, Fort Wayne, Indiana |
Authorized Official Name and Position | Deanna Derry (OWNER) |
Authorized Official Contact | 2603120171 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Deanna Derry Counseling Llc 4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 Ph: (260) 422-9372 | Deanna Derry Counseling Llc 4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 Ph: (260) 422-9372 |
NPI Number | 1992581524 |
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Provider Enumeration Date | 09/08/2023 |
Last Update Date | 09/08/2023 |
Certification Date | 09/08/2023 |
Medicare PECOS PAC ID | 7214388586 |
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Medicare Enrollment ID | O20240111000236 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992581524 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Deanna Derry |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1639955263 PECOS PAC ID: 8123479490 Enrollment ID: I20240207001372 |
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