Healthcare Provider Details

I. General information

NPI: 1750206769
Provider Name (Legal Business Name): DEREK HENNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N CHERRY ST BLDG B
FRUITA CO
81521-2101
US

IV. Provider business mailing address

143 CHELSEA CT
FRUITA CO
81521-3220
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-2527
  • Fax:
Mailing address:
  • Phone: 970-858-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLSW.0009926384
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: