Provider Demographics
NPI:1861574014
Name:MICHAELS, GARY F
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 PEBBLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1929
Mailing Address - Country:US
Mailing Address - Phone:801-565-0532
Mailing Address - Fax:
Practice Address - Street 1:8817 REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9266
Practice Address - Country:US
Practice Address - Phone:801-748-2270
Practice Address - Fax:801-748-2271
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional