Provider Demographics
NPI:1952651804
Name:VARELA, ALBERTO (PHD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:VARELA
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 1:1730 E 3100 N STE 2
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2408
Mailing Address - Country:US
Mailing Address - Phone:801-525-4645
Mailing Address - Fax:
Practice Address - Street 1:1730 E 3100 N STE 2
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2408
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103T00000X
UT11316073-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)