Provider Demographics
NPI:1316286545
Name:KRETSCHMER, DERRICK BRETT
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:BRETT
Last Name:KRETSCHMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 S MASON AVE APT 7E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-8535
Mailing Address - Country:US
Mailing Address - Phone:661-220-4947
Mailing Address - Fax:
Practice Address - Street 1:3502 S MASON AVE APT 7E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-8535
Practice Address - Country:US
Practice Address - Phone:661-220-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)