Healthcare Provider Details

I. General information

NPI: 1265180848
Provider Name (Legal Business Name): GILEAD THERAPY PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S STATE ST STE E1
OREM UT
84058-6347
US

IV. Provider business mailing address

1898 W 830 N
PROVO UT
84604-5946
US

V. Phone/Fax

Practice location:
  • Phone: 801-376-0566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BROOKE BRADFORD
Title or Position: OWNER, LCSW
Credential:
Phone: 801-376-0566