Provider Demographics
NPI:1912433657
Name:CLUFF, GAVIN S
Entity Type:Individual
Prefix:MR
First Name:GAVIN
Middle Name:S
Last Name:CLUFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 S 900 E
Mailing Address - Street 2:APT 53
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1929
Mailing Address - Country:US
Mailing Address - Phone:208-982-1751
Mailing Address - Fax:
Practice Address - Street 1:3795 S 900 E
Practice Address - Street 2:APT 53
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1929
Practice Address - Country:US
Practice Address - Phone:208-982-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician