Provider Demographics
NPI:1770247439
Name:MICHAEL VAN HOOK
Entity type:Organization
Organization Name:MICHAEL VAN HOOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:VAN HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-750-5076
Mailing Address - Street 1:4141 S MONARCH WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3168
Mailing Address - Country:US
Mailing Address - Phone:801-750-5076
Mailing Address - Fax:
Practice Address - Street 1:2725 E PARLEYS WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1667
Practice Address - Country:US
Practice Address - Phone:801-750-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty