Provider Demographics
NPI:1407967813
Name:SCOVEL, DERICK C (PHD)
Entity Type:Individual
Prefix:DR
First Name:DERICK
Middle Name:C
Last Name:SCOVEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FREDERICK
Other - Middle Name:C
Other - Last Name:SCOVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2663
Mailing Address - Country:US
Mailing Address - Phone:360-574-9565
Mailing Address - Fax:360-574-9685
Practice Address - Street 1:10000 NE 7TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4542
Practice Address - Country:US
Practice Address - Phone:360-574-9565
Practice Address - Fax:360-574-9685
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2711103TC0700X
WAPY2484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8352320Medicaid
WAG8855283Medicare ID - Type Unspecified
WA8352320Medicaid
WAP000240246Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WA8352320Medicaid