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NPI Code Detail

MEDICARE: MR. DERRICK GUTY MA, LPC

MEDICARE: MR. DERRICK GUTY MA, LPC
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
1101Y00000XCounselor6401013895MI

General Provider Information

NPI Number : 1629487194
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DERRICK GUTY MA, LPC
Provider Business Mailing Address
First Line : 1422 W SAGINAW ST
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-2434
Country : US
Telephone Number : 517-775-3871
Fax Number : 517-657-2466
Provider Business Practice Location Address
First Line : 1422 W SAGINAW ST
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-2434
Country : US
Telephone Number : 517-775-3871
Fax Number : 517-657-2466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2014
Last Update Date : 01/26/2016

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