Healthcare Provider Details

I. General information

NPI: 1023924131
Provider Name (Legal Business Name): CAREY GOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 N KAYS DR STE 210
KAYSVILLE UT
84037-4153
US

IV. Provider business mailing address

1091 LOCH LOMOND CIR
SYRACUSE UT
84075-7195
US

V. Phone/Fax

Practice location:
  • Phone: 801-738-4653
  • Fax:
Mailing address:
  • Phone: 801-505-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13714656-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: