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General NPI Number Information
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NPI Number | 1265383665
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Entity Type | Individual
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Provider Name | JAVIER GAMARRA CSW
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Gender | Male
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 628 N PUGSLEY ST
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City | SALT LAKE CTY
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State | UT
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Zip | 84103-1329
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Country | US
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Telephone | 385-261-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 N MORTON DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-4124
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13633606-6006
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13633606-3502
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License Number State | UT
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