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General NPI Number Information
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NPI Number | 1871219121
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Entity Type | Individual
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Provider Name | DEREK JOHN DEVEE TLLP
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Gender | Male
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 35 W HURON ST STE 100
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City | PONTIAC
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State | MI
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Zip | 48342-2122
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Country | US
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Telephone | 248-858-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 959 E HUDSON AVE
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-4078
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Country | US
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Telephone | 734-646-4616
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6362009632
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License Number State | MI
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