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NPI Code Detail

MEDICARE: GARY F MICHAELS

MEDICARE:   GARY F MICHAELS
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1861574014
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY F MICHAELS
Provider Business Mailing Address
First Line : 8720 PEBBLE HILLS DR
Second Line :
City : SANDY
State : UT
Zip : 84094-1929
Country : US
Telephone Number : 801-565-0532
Fax Number :
Provider Business Practice Location Address
First Line : 8817 REDWOOD RD STE A
Second Line :
City : WEST JORDAN
State : UT
Zip : 84088-9266
Country : US
Telephone Number : 801-748-2270
Fax Number : 801-748-2271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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