Active NPI
Derek J Daley
- Addiction (Substance Use Disorder) Counselor
- Loa, UT
National Provider Identifier
1114307808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 8870520-6005
- Practice address
- 56 South Main St
Loa, UT 84747 - Phone
- (801) 358-2974
- NPI assigned
- Jun 8, 2015
- Last updated
- Jun 8, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 8870520-6005 | UT | Primary |
Addresses
Primary practice location
56 South Main St
Loa, UT 84747
Mailing address
56 South Main
Loa, UT 84747
Phone (801) 358-2974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
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 |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Substance Abuse Rehabilitation Facility
- Loa, UT
- NPI 1245509918
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433721600000",
"number": "1114307808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 SOUTH MAIN",
"city": "LOA",
"state": "UT",
"postal_code": "84747",
"telephone_number": "801-358-2974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 SOUTH MAIN ST",
"city": "LOA",
"state": "UT",
"postal_code": "84747",
"telephone_number": "801-358-2974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALEY",
"first_name": "DEREK",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-08",
"last_updated": "2015-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "UT",
"license": "8870520-6005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loa, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.