Healthcare Provider Details

I. General information

NPI: 1245564574
Provider Name (Legal Business Name): TREATMENT COMPASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CREEKVIEW DR
MOAB UT
84532-3666
US

IV. Provider business mailing address

2615 CREEKVIEW DR
MOAB UT
84532-3666
US

V. Phone/Fax

Practice location:
  • Phone: 435-459-1043
  • Fax:
Mailing address:
  • Phone: 435-459-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DERRICK WILLIAM COOK
Title or Position: PRESIDENT
Credential: MAEDC, LPC
Phone: 435-459-1043