Provider Demographics
NPI:1912377458
Name:SEBREE, DERRICK JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:
Last Name:SEBREE
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30875 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4203
Mailing Address - Country:US
Mailing Address - Phone:248-416-7740
Mailing Address - Fax:
Practice Address - Street 1:120 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2610
Practice Address - Country:US
Practice Address - Phone:248-416-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical