Doctor Name: | MS. SANDRA L DERAU |
NPI Number: | 1609165208 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | LPC-2145 |
Business Practice Address: | 730 W Hermosa Dr Wickenburg, AZ - 853901245 |
Business Phone Number: | 9286710792 |
Business Fax Number: | 9286841316 |
Mailing Address: | 730 W Hermosa Dr, WICKENBURG |
State: | AZ |
Postal Code: | 853901245 |
Phone Number: | 9286710792 |
Fax Number: | 9286841316 |
NPI Enumeration Date: | 04/04/2011 |
NPI Last Update Date: | 04/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-2145 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |