Individual
DR. HEATHER R. DERIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1450 E 10TH ST, ROLLA, MO 65401-3648
(573) 364-7551
(816) 318-3045
Mailing address
1450 E 10TH ST, ROLLA, MO 65401-3648
(573) 364-7551
(816) 318-3045
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
8291
NE
101YM0800X
Mental Health Counselor
2008019412
MO
103TC0700X
Clinical Psychologist
Primary
2008034835
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470798717-26
—
NE
05
—
470798717-27
—
NE
05
—
470798717-29
—
NE
01
—
98534
AUXILARY BCBS
NE
Enumeration date
05/21/2007
Last updated
06/17/2011
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