Derek Harris, CAC II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

ACB-7361 Issued in CO

Practice address

216 N 3Rd St
Sterling, CO 80751-4302

Phone

(970) 526-6577

Fax

(970) 965-0059

NPI assigned

Jul 11, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589500800000",
    "number": "1982969333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W MAIN ST",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807513168",
            "telephone_number": "970-522-4549",
            "fax_number": "970-522-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N 3RD ST",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514302",
            "telephone_number": "970-526-6577",
            "fax_number": "970-965-0059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 W Main St",
            "address_purpose": "LOCATION",
            "city": "Sterling",
            "state": "CO",
            "postal_code": "807513168",
            "country_code": "US",
            "telephone_number": "970-522-4549",
            "fax_number": "970-522-4211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "DEREK",
        "credential": "CAC II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-11",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACB-7361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Healthone Clinic Services - Pediatric Specialties LLC

• All providers in Sterling, CO
• Addiction (Substance Use Disorder) Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; 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.