Provider Demographics
NPI:1093490427
Name:GALE, GARY MILTON
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MILTON
Last Name:GALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MILTON
Other - Middle Name:
Other - Last Name:GALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1220 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4014
Mailing Address - Country:US
Mailing Address - Phone:385-202-4685
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4014
Practice Address - Country:US
Practice Address - Phone:385-202-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT318065-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker