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NPI Code Detail

MEDICARE: MR. DEREK PAUL DAVIS LCSW

MEDICARE: MR. DEREK PAUL DAVIS LCSW
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
11041C0700XClinical Social Worker139877-3501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107001373101OTHERUTINTERMOUNTAIN HEALTH CARE
2261878OTHERUTDESERET MUTUAL
3942938348DAVOTHERUTEDUCATORS MUTUAL
4942938348OTHERUTCHAMPUS

General Provider Information

NPI Number : 1386624625
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEREK PAUL DAVIS LCSW
Provider Business Mailing Address
First Line : PO BOX 270
Second Line :
City : PROVO
State : UT
Zip : 84603-0270
Country : US
Telephone Number : 801-344-4400
Fax Number :
Provider Business Practice Location Address
First Line : 1300 E CENTER ST
Second Line :
City : PROVO
State : UT
Zip : 84606-3554
Country : US
Telephone Number : 801-344-4215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 06/28/2019

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