Provider Demographics
NPI:1770819153
Name:CROSLAND, DARWIN PHIL (CMHC)
Entity type:Individual
Prefix:MR
First Name:DARWIN
Middle Name:PHIL
Last Name:CROSLAND
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 E 200 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1047
Mailing Address - Country:US
Mailing Address - Phone:801-989-4873
Mailing Address - Fax:801-779-0255
Practice Address - Street 1:49 E 200 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1047
Practice Address - Country:US
Practice Address - Phone:801-989-4873
Practice Address - Fax:801-779-0255
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT283932-6004101YP2500X, 101YA0400X
WYLPC-1421101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT88539717Medicaid