Individual
MR. DEREK JAMES THOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, BCBA
Contact information
Practice address
1428 44TH ST SW STE B, WYOMING, MI 49509-4312
(616) 604-8492
Mailing address
1428 44TH ST SW STE B, WYOMING, MI 49509-4312
(616) 604-8492
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-32583
MI
Other
Enumeration date
05/21/2018
Last updated
01/04/2019
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