Provider Demographics
NPI:1285813691
Name:CHILES, AUSTIN M JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:M
Last Name:CHILES
Suffix:JR
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 1:447 N 300 W STE 7
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4203
Mailing Address - Country:US
Mailing Address - Phone:801-721-7878
Mailing Address - Fax:801-544-3819
Practice Address - Street 1:447 N 300 W STE 7
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4203
Practice Address - Country:US
Practice Address - Phone:801-721-7878
Practice Address - Fax:801-544-3819
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114074-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007420Medicare UPIN