| Organization Name: | JEFFREY DEGROAT PHD PLLC |
| NPI Number: | 1104066679 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY DEGROAT (MANAGER) |
| Mailing Address: | 21929 E 9 Mile Rd Saint Clair Shores |
| State: | MI US |
| Postal Code: | 480802906 |
| Phone Number: | 5867763366 |
| Fax Number: | |
| NPI Enumeration Date: | 02/24/2009 |
| NPI Last Update Date: | 02/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301012619 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |