Healthcare Provider Details

I. General information

NPI: 1225408909
Provider Name (Legal Business Name): COURTNEY GIFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E 2400 N
NORTH LOGAN UT
84341-2902
US

IV. Provider business mailing address

1443 W 800 N STE 103
OREM UT
84057-2878
US

V. Phone/Fax

Practice location:
  • Phone: 307-871-0695
  • Fax:
Mailing address:
  • Phone: 801-655-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-37993
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: