# GERALD LOUIS COSTLEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164910089
- **Gender:** Man
- **Credential:** LCSW

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | 128158-3501 | UT | — |
| 101YM0800X | Mental Health Counselor | 128158-3501 | UT | Yes |

## Other

- **Enumeration date:** 04/26/2018
- **Last updated:** 12/29/2019