Provider Demographics
NPI:1255840021
Name:GERALD, MICHAEL ESTEBAN (CMHC, LMHC, CRC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ESTEBAN
Last Name:GERALD
Suffix:
Gender:M
Credentials:CMHC, LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 OLD MAIN HILL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6405
Mailing Address - Country:US
Mailing Address - Phone:435-797-3401
Mailing Address - Fax:
Practice Address - Street 1:6405 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6405
Practice Address - Country:US
Practice Address - Phone:435-797-3401
Practice Address - Fax:844-308-5865
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086738101YM0800X
UT11891260-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health