Provider Demographics
NPI:1871219121
Name:DEVEE, DEREK JOHN (TLLP)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JOHN
Last Name:DEVEE
Suffix:
Gender:M
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 E HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4078
Mailing Address - Country:US
Mailing Address - Phone:734-646-4616
Mailing Address - Fax:
Practice Address - Street 1:35 W HURON ST STE 100
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2122
Practice Address - Country:US
Practice Address - Phone:248-858-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty