Provider Demographics
NPI:1194463133
Name:BARNEY, DEREK BRUCE
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:BRUCE
Last Name:BARNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 W 2440 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-7731
Mailing Address - Country:US
Mailing Address - Phone:435-220-7005
Mailing Address - Fax:
Practice Address - Street 1:85 NORTH 300 WEST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780
Practice Address - Country:US
Practice Address - Phone:435-229-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9550269-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health