Provider Demographics
NPI:1124366950
Name:DERROR, CRAIG ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:DERROR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 E 13TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8126
Mailing Address - Country:US
Mailing Address - Phone:231-878-3059
Mailing Address - Fax:
Practice Address - Street 1:9116 E 13TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8126
Practice Address - Country:US
Practice Address - Phone:231-878-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013463103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral