Provider Demographics
NPI:1689998221
Name:DERIX, CHRISTOPHER (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DERIX
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 1:4142 KEATON CROSSING BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8406
Mailing Address - Country:US
Mailing Address - Phone:573-364-7551
Mailing Address - Fax:
Practice Address - Street 1:3408 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6506
Practice Address - Country:US
Practice Address - Phone:515-207-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010007876101YP2500X
MO2011032573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional