Provider Demographics
NPI:1518048917
Name:MAYER, GREGORY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:MAYER
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 1:4699 HARRISON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4396
Mailing Address - Country:US
Mailing Address - Phone:801-479-8286
Mailing Address - Fax:801-479-8247
Practice Address - Street 1:4699 HARRISON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4396
Practice Address - Country:US
Practice Address - Phone:801-479-8286
Practice Address - Fax:801-479-8247
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1160862501103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R34528Medicare UPIN