MEDICARE: MICHAEL VAN HOOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1770247439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL VAN HOOK

Provider Business Mailing Address
First Line	:	4141 S MONARCH WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3168
Country	:	US
Telephone Number	:	801-750-5076
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 E PARLEYS WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1667
Country	:	US
Telephone Number	:	801-750-5076
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	LAURA KATE VAN HOOK
Credential	:	LCSW
Telephone Number	:	801-750-5076

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	10/28/2021

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