Provider Demographics
NPI:1528401957
Name:MICHELLE GOURLEY & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MICHELLE GOURLEY & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GOURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, LCSW, JD
Authorized Official - Phone:801-209-2220
Mailing Address - Street 1:1390 S 1100 E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2461
Mailing Address - Country:US
Mailing Address - Phone:801-209-2220
Mailing Address - Fax:801-384-0499
Practice Address - Street 1:1390 S 1100 E
Practice Address - Street 2:SUITE 203
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2461
Practice Address - Country:US
Practice Address - Phone:801-209-2220
Practice Address - Fax:801-384-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health