MEDICARE: KARLEY DEERING

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
1	101YM0800X	Mental Health Counselor	6401013013	MI

General Provider Information

NPI Number	:	1356764757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLEY DEERING

Provider Business Mailing Address
First Line	:	948 ARLINGTON ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3804
Country	:	US
Telephone Number	:	616-824-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 BALL AVE. NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3804
Country	:	US
Telephone Number	:	616-456-6571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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Directions to “ KARLEY DEERING ” Practice Location

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