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Individual

MR. GLENN L DERRICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.A., L.L.P.

Contact information

Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7703
(734) 785-7733
Mailing address
142 E OAKRIDGE ST, FERNDALE, MI 48220-1333
(248) 544-0280

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361005250
MI

Other

Enumeration date
03/22/2007
Last updated
09/27/2025
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