Provider Demographics
NPI:1720381296
Name:SCHWEBACH, DEREK JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JOHN
Last Name:SCHWEBACH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 W 700 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-9781
Mailing Address - Country:US
Mailing Address - Phone:801-696-8225
Mailing Address - Fax:
Practice Address - Street 1:2028 W 500 N STE B
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-8283
Practice Address - Country:US
Practice Address - Phone:435-219-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4861517-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical