Provider Demographics
NPI:1992573802
Name:STAHL, DERRICK D'ARTAGNON (PSYD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:D'ARTAGNON
Last Name:STAHL
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:PO BOX 290262
Mailing Address - Street 2:
Mailing Address - City:YIGO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-3034
Mailing Address - Country:US
Mailing Address - Phone:717-880-1667
Mailing Address - Fax:
Practice Address - Street 1:BLDG 14010
Practice Address - Street 2:CAROLINAS AVE
Practice Address - City:ANDERSEN AFB
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:717-880-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist