| Deanna Derry Counseling Llc | |
|
4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 | |
| (260) 422-9372 | |
| (260) 422-0843 |
| Full Name | Deanna Derry Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4656 W Jefferson Blvd Ste 285, Fort Wayne, Indiana |
| Authorized Official Name and Position | Deanna Derry (OWNER) |
| Authorized Official Contact | 2603120171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deanna Derry Counseling Llc 4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 Ph: (260) 422-9372 | Deanna Derry Counseling Llc 4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 Ph: (260) 422-9372 |
| NPI Number | 1992581524 |
|---|---|
| Provider Enumeration Date | 09/08/2023 |
| Last Update Date | 09/08/2023 |
| Certification Date | 09/08/2023 |
| Medicare PECOS PAC ID | 7214388586 |
|---|---|
| Medicare Enrollment ID | O20240111000236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992581524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Deanna Derry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639955263 PECOS PAC ID: 8123479490 Enrollment ID: I20240207001372 |
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