Provider Demographics
NPI:1629564976
Name:BUGG, DERICK (NCC)
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:BUGG
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19201 TWIN PONDS RD
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9220
Mailing Address - Country:US
Mailing Address - Phone:480-747-5168
Mailing Address - Fax:
Practice Address - Street 1:19201 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9220
Practice Address - Country:US
Practice Address - Phone:480-747-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health