Doctor Name: | DERRICK SKINNER |
NPI Number: | 1003219387 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 441 E Market St Celina, OH - 458221736 |
Business Phone Number: | 4195866628 |
Business Fax Number: | |
Mailing Address: | 441 E Market St, CELINA |
State: | OH |
Postal Code: | 458221736 |
Phone Number: | 4195866628 |
Fax Number: | |
NPI Enumeration Date: | 10/01/2014 |
NPI Last Update Date: | 10/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |