Provider Demographics
NPI:1336370907
Name:ROMERO, GALEN RONNIE (CMHC)
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:RONNIE
Last Name:ROMERO
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0460
Mailing Address - Country:US
Mailing Address - Phone:801-298-3446
Mailing Address - Fax:801-298-3449
Practice Address - Street 1:811 N HARRISVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-3537
Practice Address - Country:US
Practice Address - Phone:801-399-1818
Practice Address - Fax:801-782-8412
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT364777-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1336370907Medicaid