Basic Information
| Provider Information | |||||||||
| NPI: | 1689998221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERIX | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4142 KEATON CROSSING BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | O FALLON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633688406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733647551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 913 S PERSHING AVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655601845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737296222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2010 | ||||||||
| LastUpdateDate: | 10/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2010007876 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC0700X | 2011032573 | MO | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.