Doctor Name: | DR. JERRY REDD |
NPI Number: | 1093111999 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD, CMHC |
License Number: | 55044786004 |
Business Practice Address: | 1364 W State Rd Suite 204 Pleasant Grove, UT - 840624109 |
Business Phone Number: | 8017858885 |
Business Fax Number: | |
Mailing Address: | 1364 W State Rd, Suite 204 PLEASANT GROVE |
State: | UT |
Postal Code: | 840624109 |
Phone Number: | 8017858885 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2014 |
NPI Last Update Date: | 11/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 55044786004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |