Provider Demographics
NPI:1215254255
Name:GAILEY, CHRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GAILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 NICHOLLS RD
Mailing Address - Street 2:
Mailing Address - City:FRUIT HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3309
Mailing Address - Country:US
Mailing Address - Phone:801-928-1403
Mailing Address - Fax:
Practice Address - Street 1:872 NICHOLLS RD
Practice Address - Street 2:
Practice Address - City:FRUIT HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84037-3309
Practice Address - Country:US
Practice Address - Phone:801-928-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT309138-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional