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NPI Code Detail

MEDICARE: CHRISTOPHER DARRELL DEGRAFF PH.D

MEDICARE: CHRISTOPHER DARRELL DEGRAFF PH.D
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 PsychologistPSY0203NV

General Provider Information

NPI Number : 1679612493
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER DARRELL DEGRAFF PH.D
Provider Business Mailing Address
First Line : 343 FAIRVIEW DR STE 104
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-5389
Country : US
Telephone Number : 775-887-1817
Fax Number :
Provider Business Practice Location Address
First Line : 343 FAIRVIEW DR STE 104
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-5389
Country : US
Telephone Number : 775-887-1817
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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