Healthcare Provider Details

I. General information

NPI: 1679612493
Provider Name (Legal Business Name): CHRISTOPHER DARRELL DEGRAFF PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 FAIRVIEW DR STE 104
CARSON CITY NV
89701-5389
US

IV. Provider business mailing address

343 FAIRVIEW DR STE 104
CARSON CITY NV
89701-5389
US

V. Phone/Fax

Practice location:
  • Phone: 775-887-1817
  • Fax:
Mailing address:
  • Phone: 775-887-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY0203
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: