Healthcare Provider Details

I. General information

NPI: 1457265381
Provider Name (Legal Business Name): DEREK ULRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E LANCASTER AVE
SHILLINGTON PA
19607-2633
US

IV. Provider business mailing address

33 MELLOWBROOK DR
READING PA
19608-8967
US

V. Phone/Fax

Practice location:
  • Phone: 484-324-0782
  • Fax:
Mailing address:
  • Phone: 610-223-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: