Individual
MARK JOHN DERBAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
8503 75TH ST., SUITE A, KENOSHA, WI 53142-7620
(262) 654-9370
(262) 654-9379
Mailing address
8503 75TH ST., SUITE A, KENOSHA, WI 53142-7620
(262) 654-9370
(262) 654-9379
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1347-226
WI
Other
Enumeration date
04/25/2012
Last updated
07/19/2021
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