Provider Demographics
NPI:1932225323
Name:PEHLE, DEREK ELSER (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ELSER
Last Name:PEHLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 J ST STE 411
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0844
Mailing Address - Country:US
Mailing Address - Phone:209-544-1031
Mailing Address - Fax:
Practice Address - Street 1:1024 J ST STE 411
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0844
Practice Address - Country:US
Practice Address - Phone:209-544-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21361103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist