Provider Demographics
NPI:1578234001
Name:ATKINS, DEREK (MA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ATKINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 ELDORADO PKWY STE 227
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6198
Mailing Address - Country:US
Mailing Address - Phone:469-712-5481
Mailing Address - Fax:214-856-3375
Practice Address - Street 1:6401 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5887
Practice Address - Country:US
Practice Address - Phone:469-712-5481
Practice Address - Fax:214-856-3375
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty