Provider Demographics
NPI:1710398532
Name:ROUNDY, GARRET (AMFT)
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:
Last Name:ROUNDY
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7337 S CHRIS LN
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4803
Mailing Address - Country:US
Mailing Address - Phone:801-592-2429
Mailing Address - Fax:
Practice Address - Street 1:3507 N UNIVERSITY AVE
Practice Address - Street 2:#350
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4478
Practice Address - Country:US
Practice Address - Phone:801-477-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT82009373904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist