Healthcare Provider Details

I. General information

NPI: 1740902139
Provider Name (Legal Business Name): GABRIELLA HOOPER GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 E FORT UNION BLVD STE 104
MIDVALE UT
84047-5531
US

IV. Provider business mailing address

1156 E 3300 #413
SALT LAKE CITY UT
84106
US

V. Phone/Fax

Practice location:
  • Phone: 801-984-1717
  • Fax: 801-984-1717
Mailing address:
  • Phone: 757-371-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13991672-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: