Most Relevant Information
Provider Data
| NPI Number: | 1003231473 |
| Provider Name: | SETH THOMAS DERRICK |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/21/2014 |
| Last Updated: | 06/07/2021 |
Provider Practice Location
900 E MAIN ST STE 201
GRASS VALLEY
CA
959455853
Practice Location Phone/Fax
| Phone: | 5308026993 |
| Fax: |
Provider Mailing Location
900 E MAIN ST STE 201
GRASS VALLEY
CA
959455853
Provider Mailing Phone/Fax
| Phone: | 5308026993 |
| Fax: |