Provider Demographics
NPI:1073656427
Name:GILES, GERET NOLAN (PHD)
Entity Type:Individual
Prefix:
First Name:GERET
Middle Name:NOLAN
Last Name:GILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S STATE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6326
Mailing Address - Country:US
Mailing Address - Phone:801-225-9522
Mailing Address - Fax:801-225-9498
Practice Address - Street 1:703 S STATE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6326
Practice Address - Country:US
Practice Address - Phone:801-225-9522
Practice Address - Fax:801-225-9498
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334087-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist