Healthcare Provider Details

I. General information

NPI: 1164345823
Provider Name (Legal Business Name): DEEGAN EGGLESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN ST STE A
SAINT JOSEPH MI
49085-3100
US

IV. Provider business mailing address

800 WESTVIEW ST APT 168
YPSILANTI MI
48197
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-1688
  • Fax:
Mailing address:
  • Phone: 518-368-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: