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NPI Code Detail

MEDICARE: DARICE DARBY TLLP

MEDICARE: DARICE DARBY TLLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist6301016087MI

General Provider Information

NPI Number : 1336685692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARICE DARBY TLLP
Provider Business Mailing Address
First Line : 10069 PORTAGE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49002-7249
Country : US
Telephone Number : 269-532-0444
Fax Number :
Provider Business Practice Location Address
First Line : 625 HARRISON ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-3681
Country : US
Telephone Number : 269-323-1954
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2017
Last Update Date : 03/03/2020

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1750861027 — MS. BUNNY REA JOHNSON LLMSW
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Directions to “ DARICE DARBY TLLP” Practice Location

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