Provider Demographics
NPI:1033416516
Name:CAMPBELL, GABRIELLA (CMHC)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:AUTHENTIC SELF
Other - Middle Name:
Other - Last Name:COUNSELING, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5965 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1720
Mailing Address - Country:US
Mailing Address - Phone:801-263-7100
Mailing Address - Fax:
Practice Address - Street 1:746 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4229
Practice Address - Country:US
Practice Address - Phone:801-915-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8336681-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health