Individual
DERREL JEFFREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
345 OWEN LN STE 122, WACO, TX 76710-5583
(254) 218-2389
(855) 396-2470
Mailing address
4906 LAKE ENGLEWOOD DR, WACO, TX 76710-2938
(254) 218-2389
(855) 396-2470
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
35597
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178626101
—
TX
Enumeration date
11/14/2006
Last updated
08/08/2020
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