Provider Demographics
NPI:1922236363
Name:GUBLER, LYNDEE
Entity Type:Individual
Prefix:
First Name:LYNDEE
Middle Name:
Last Name:GUBLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-4106
Mailing Address - Country:US
Mailing Address - Phone:801-787-4739
Mailing Address - Fax:
Practice Address - Street 1:1361 N 1075 W STE 11B
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2876
Practice Address - Country:US
Practice Address - Phone:801-787-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid