MEDICARE: DERREL J. HIGGINS LMFT

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	106H00000X	Marriage & Family Therapist	LMFT-10202	AZ

General Provider Information

NPI Number	:	1750385589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERREL J. HIGGINS LMFT

Provider Business Mailing Address
First Line	:	2328 N GLENVIEW
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-2394
Country	:	US
Telephone Number	:	480-593-3208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 E UNIVERSITY DR
Second Line	:	STE 103
City	:	MESA
State	:	AZ
Zip	:	85213-8384
Country	:	US
Telephone Number	:	480-593-3208
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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