MEDICARE: CAITLIN REBECCA GALT LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7290233-6004	UT

General Provider Information

NPI Number	:	1063118693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN REBECCA GALT LCMHC

Provider Business Mailing Address
First Line	:	1430 E KENSINGTON AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2654
Country	:	US
Telephone Number	:	801-608-1934
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 E 900 S STE 6
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4241
Country	:	US
Telephone Number	:	801-608-1934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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