Individual
GERALD LOUIS COSTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
339 E 3900 S STE 155, SALT LAKE CITY, UT 84107-1978
(801) 347-0370
(801) 261-3701
Mailing address
339 E 3900 S STE 155, SALT LAKE CITY, UT 84107-1978
(801) 347-0370
(801) 261-3701
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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