Provider Demographics
NPI:1477091650
Name:LEFEVOR, GARY TYLER (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:TYLER
Last Name:LEFEVOR
Suffix:
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 1:6405 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:844-308-5865
Practice Address - Street 1:6405 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-1624
Practice Address - Country:US
Practice Address - Phone:435-797-3401
Practice Address - Fax:844-308-5865
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
UT11642799-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling