Healthcare Provider Details

I. General information

NPI: 1952233215
Provider Name (Legal Business Name): QUANTAVIOUS GOLETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 S STATE ST
CLEARFIELD UT
84015-1600
US

IV. Provider business mailing address

955 COUNTRY HILLS DR
SOUTH OGDEN UT
84403-2477
US

V. Phone/Fax

Practice location:
  • Phone: 385-290-0027
  • Fax:
Mailing address:
  • Phone: 903-701-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: