Provider Demographics
NPI:1093394348
Name:GILLIES, HAYDEN LIMB
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:LIMB
Last Name:GILLIES
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 1:1021 S 2740 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-6334
Mailing Address - Country:US
Mailing Address - Phone:801-836-0129
Mailing Address - Fax:801-383-0246
Practice Address - Street 1:95 S 100 E
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2252
Practice Address - Country:US
Practice Address - Phone:801-382-9338
Practice Address - Fax:801-383-0246
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106H00000X
UT9876235-3904106H00000X
UT9876235-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist