MEDICARE: MS. GINA GAMMON SEARLE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	291591-6004	UT

General Provider Information

NPI Number	:	1154390870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA GAMMON SEARLE MA

Provider Business Mailing Address
First Line	:	PO BOX 71193
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-0193
Country	:	US
Telephone Number	:	801-209-6243
Fax Number	:	801-676-9887

Provider Business Practice Location Address
First Line	:	2225 E MURRAY HOLLADAY RD STE 108
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117-5384
Country	:	US
Telephone Number	:	801-209-6243
Fax Number	:	801-676-9887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	08/10/2023

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