Derek J Daley
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Loa, UT
NPI 1114307808 · NPPES record last updated Jun 8, 2015
Key facts
- NPI
- 1114307808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 8870520-6005 (UT)
- Practice address
- 56 South Main St
Loa, UT 84747 - Phone
- (801) 358-2974
- NPI assigned
- Jun 8, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8870520-6005 | UT | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Outdoor Adventures LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 8870520-6005 | UT | Yes |
Addresses
Primary practice location
56 South Main St
Loa, UT 84747
Mailing address
56 South Main
Loa, UT 84747
Phone (801) 358-2974
Other providers in Loa, UT
- Aspen Ranch
- Central Utah Mental Health Substance Abuse
- Colleen Chappell
- Raylynne J Cooper
- County of Wayne
- Equine Journeys, LLC
- Christyn Gerber
- Ashlie Marie Harris
- Juniper Canyon Recovery Center for Women, LLC
- Stephen Kern
All providers in Loa, UT · Addiction (Substance Use Disorder) Counselor in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.