Tina Derrick, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

075285 Issued in IA

Practice address

1063 14TH PL Ste a
Des Moines, IA 50314-1245

Phone

(515) 235-5224

NPI assigned

Dec 12, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Innovative Counseling & Consulting, Inc.

  • Mental Health Counselor
  • Des Moines, IA
  • NPI 1275873499
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418342400000",
    "number": "1194123778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1063 14TH PL STE A",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141245",
            "telephone_number": "515-235-5224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1063 14TH PL STE A",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141245",
            "telephone_number": "515-235-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "TINA",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-12",
        "last_updated": "2014-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IA",
            "license": "075285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600884423",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Department of Veterans Affairs Central Iowa Health Care System
• Aditi Derashri, MD
• Megan Dereus
• Dustin David Derflinger, D.O.
• Catherine Marie Derksen, LMSW
• Britt K Deruyter, M.D.
• Ravinder K Dervesh, MD
• Tripti Dervesh, DDS
• Des Moines Anesthesia and Pain Management
• Des Moines Anesthesiologists PC

• Social Worker in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.