Provider Demographics
NPI:1649143769
Name:A WAY BACK COUNSELING PLLC
Entity type:Organization
Organization Name:A WAY BACK COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:435-220-7005
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:833-788-2086
Practice Address - Street 1:101 N 300 W
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2701
Practice Address - Country:US
Practice Address - Phone:435-220-7005
Practice Address - Fax:833-788-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1194463133Medicaid