MEDICARE: CHRISTOPHER DERIX PSYD

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	103TC0700X	Clinical Psychologist	2011032573	MO

General Provider Information

NPI Number	:	1689998221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER DERIX PSYD

Provider Business Mailing Address
First Line	:	1200 LAKE SAINT LOUIS BLVD # 301
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-1325
Country	:	US
Telephone Number	:	515-207-5226
Fax Number	:

Provider Business Practice Location Address
First Line	:	3408 WOODLAND AVE
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-207-5226
Fax Number	:

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

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	01/29/2026

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