Provider Demographics
NPI:1548449671
Name:DEAGRO, MICHAEL KING JR (MS, LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KING
Last Name:DEAGRO
Suffix:JR
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2431
Mailing Address - Country:US
Mailing Address - Phone:231-946-4006
Mailing Address - Fax:
Practice Address - Street 1:223 W GRANDVIEW PKWY STE 9
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2277
Practice Address - Country:US
Practice Address - Phone:231-946-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional