Provider Demographics
NPI:1619902079
Name:GAMBLES, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GAMBLES
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 1:3516 W 8070 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4575
Mailing Address - Country:US
Mailing Address - Phone:801-265-3053
Mailing Address - Fax:
Practice Address - Street 1:1323 W 7900 S
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-7933
Practice Address - Country:US
Practice Address - Phone:801-440-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT317599-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical