Individual
MR. DEREK PAUL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1300 E CENTER ST, PROVO, UT 84606-3554
(801) 344-4215
Mailing address
PO BOX 270, PROVO, UT 84603-0270
(801) 344-4400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
139877-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107001373101
INTERMOUNTAIN HEALTH CARE
UT
01
—
261878
DESERET MUTUAL
UT
01
—
942938348
CHAMPUS
UT
01
—
942938348DAV
EDUCATORS MUTUAL
UT
Enumeration date
01/20/2006
Last updated
06/28/2019
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