Provider Demographics
NPI:1235501404
Name:GILES, HADERLIE & ASSOCIATES FAMILY PSYCHOLOGY
Entity Type:Organization
Organization Name:GILES, HADERLIE & ASSOCIATES FAMILY PSYCHOLOGY
Other - Org Name:GILES & ASSOCIATES FAMILY PSYCHOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERET
Authorized Official - Middle Name:N
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-785-4622
Mailing Address - Street 1:233 S PLEASANT GROVE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2878
Mailing Address - Country:US
Mailing Address - Phone:801-785-4622
Mailing Address - Fax:801-785-4623
Practice Address - Street 1:330 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2052
Practice Address - Country:US
Practice Address - Phone:801-491-6394
Practice Address - Fax:801-491-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334087-2501103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty