Healthcare Provider Details

I. General information

NPI: 1043284953
Provider Name (Legal Business Name): GAIL TAYLOR SZYKULA M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 E 3300 S
SALT LAKE CITY UT
84106-3370
US

IV. Provider business mailing address

1545 E 3300 S
SALT LAKE CITY UT
84106-3370
US

V. Phone/Fax

Practice location:
  • Phone: 801-478-2780
  • Fax: 801-478-2781
Mailing address:
  • Phone: 801-478-2780
  • Fax: 801-478-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number332921-6004
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier33292160001001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier50504
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerPEHP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: