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Individual
GERALD LOUIS COSTLEY
Active
Individual
GERALD LOUIS COSTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
128158-3501
UT
101YM0800X
Mental Health Counselor
Primary
128158-3501
UT
Other
Enumeration date
04/26/2018
Last updated
12/29/2019
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