Individual
DEREK BENJAMIN CARMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSS, CSW
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12267033-3502
UT
175T00000X
Peer Specialist
884
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/17/2019
Last updated
07/20/2021
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