Provider Demographics
NPI:1750057105
Name:GALE, DORALIE (MFT GRADUATE STUDENT)
Entity Type:Individual
Prefix:
First Name:DORALIE
Middle Name:
Last Name:GALE
Suffix:
Gender:F
Credentials:MFT GRADUATE STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 S 1430 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3636
Mailing Address - Country:US
Mailing Address - Phone:435-749-2173
Mailing Address - Fax:
Practice Address - Street 1:276 E 950 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7054
Practice Address - Country:US
Practice Address - Phone:801-845-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist