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NPI Code Detail

MEDICARE: DEREL LUX

MEDICARE: DEREL LUX
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1831462845
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREL LUX
Provider Business Mailing Address
First Line : 111 N COUNTY FARM RD
Second Line :
City : WHEATON
State : IL
Zip : 60187-3977
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 422 N PROSPECT ST
Second Line :
City : WHEATON
State : IL
Zip : 60187-5839
Country : US
Telephone Number : 630-682-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2012
Last Update Date : 02/22/2012

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Directions to “ DEREL LUX ” Practice Location

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