Provider Demographics
NPI:1457430621
Name:DERSCH, CHARETTE ALYSE (PHD, LMFT-S)
Entity Type:Individual
Prefix:DR
First Name:CHARETTE
Middle Name:ALYSE
Last Name:DERSCH
Suffix:
Gender:F
Credentials:PHD, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6173
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5105
Mailing Address - Country:US
Mailing Address - Phone:214-529-3698
Mailing Address - Fax:972-542-1385
Practice Address - Street 1:6951 VIRGINIA PKWY
Practice Address - Street 2:SUITE 309
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5713
Practice Address - Country:US
Practice Address - Phone:214-529-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004924042425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist