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General NPI Number Information
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NPI Number | 1164345823
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Entity Type | Individual
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Provider Name | DEEGAN EGGLESTON
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Gender | Male
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 415 MAIN ST STE A
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3100
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Country | US
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Telephone | 269-408-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WESTVIEW ST APT 168
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City | YPSILANTI
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State | MI
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Zip | 48197
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Country | US
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Telephone | 518-368-7643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451025008
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License Number State | MI
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