Provider Demographics
NPI:1871720888
Name:HAGEY, DEREK WILLIS (LMFT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:WILLIS
Last Name:HAGEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 E FICUS WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MTN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5741
Mailing Address - Country:US
Mailing Address - Phone:801-200-2506
Mailing Address - Fax:
Practice Address - Street 1:4095 E PONY EXPRESS PKWY STE 15
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5529
Practice Address - Country:US
Practice Address - Phone:801-200-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH159106H00000X
MA1453106H00000X
UT7684356-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist