Provider Demographics
NPI:1497030175
Name:MARTIN, GERRAD SHELDON (CMHC, DBH)
Entity Type:Individual
Prefix:MR
First Name:GERRAD
Middle Name:SHELDON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CMHC, DBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057
Mailing Address - Country:US
Mailing Address - Phone:801-372-9434
Mailing Address - Fax:801-434-8333
Practice Address - Street 1:309 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-372-9434
Practice Address - Fax:801-434-8333
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7379789-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health