MEDICARE: MICHAEL KING DEAGRO JR. M.S., L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401008418	MI

General Provider Information

NPI Number	:	1548449671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KING DEAGRO JR. M.S., L.P.C.

Provider Business Mailing Address
First Line	:	426 W 7TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2431
Country	:	US
Telephone Number	:	231-946-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 W GRANDVIEW PKWY STE 9
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2277
Country	:	US
Telephone Number	:	231-946-4006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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