Derrik R Tollefson, PHD
Individual provider Active NPI Mental Health Counselor · Hyrum, UT
NPI 1992766463 · NPPES record last updated Sep 25, 2024
Key facts
- NPI
- 1992766463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 295335-3501 (UT)
- Practice address
- 347 S Center St
Hyrum, UT 84319-1604 - Phone
- (435) 621-2992
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 295335-3501 | UT | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 295335-3501 | UT | Yes |
Addresses
Primary practice location
347 S Center St
Hyrum, UT 84319-1604
Mailing address
347 S Center St
Hyrum, UT 84319-1604
Phone (435) 621-2992
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All providers in Hyrum, UT · Mental Health 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 Sep 25, 2024. 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.