Provider Demographics
NPI:1154390870
Name:SEARLE, GINA GAMMON (MA)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:GAMMON
Last Name:SEARLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71193
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0193
Mailing Address - Country:US
Mailing Address - Phone:801-209-6243
Mailing Address - Fax:801-676-9887
Practice Address - Street 1:2225 E MURRAY HOLLADAY RD STE 108
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5384
Practice Address - Country:US
Practice Address - Phone:801-209-6243
Practice Address - Fax:801-676-9887
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT291591-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional