Provider Demographics
NPI:1326390634
Name:BARLOW, CHANEL CARLILE (CMHC)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:CARLILE
Last Name:BARLOW
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:RANAE
Other - Last Name:CARLILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 W 4075 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1067
Mailing Address - Country:US
Mailing Address - Phone:801-710-9205
Mailing Address - Fax:
Practice Address - Street 1:324 W 4075 N
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84414-1067
Practice Address - Country:US
Practice Address - Phone:801-710-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9433404-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health