Provider Demographics
NPI:1811418502
Name:DEERY, CHRISTOPHER DIDIER (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DIDIER
Last Name:DEERY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 COTTAGEVIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2392
Mailing Address - Country:US
Mailing Address - Phone:231-642-2778
Mailing Address - Fax:231-252-1330
Practice Address - Street 1:810 COTTAGEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2392
Practice Address - Country:US
Practice Address - Phone:231-642-2778
Practice Address - Fax:231-252-1330
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015321101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor