Provider Demographics
NPI:1700031408
Name:GONZALEZ BOAS, KEVIN JASON KOA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JASON KOA
Last Name:GONZALEZ BOAS
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 1:1488 E 3045 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3414
Mailing Address - Country:US
Mailing Address - Phone:385-228-0556
Mailing Address - Fax:
Practice Address - Street 1:1488 E 3045 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3414
Practice Address - Country:US
Practice Address - Phone:385-228-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor