Provider Demographics
NPI:1366860777
Name:ARIEL GONZALES PSYCHIATRIC NP, PLLC
Entity type:Organization
Organization Name:ARIEL GONZALES PSYCHIATRIC NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-746-7190
Mailing Address - Street 1:5691 S REDWOOD RD
Mailing Address - Street 2:BLDG 16, STE 1B
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5420
Mailing Address - Country:US
Mailing Address - Phone:801-746-7190
Mailing Address - Fax:866-284-3243
Practice Address - Street 1:5691 S REDWOOD RD
Practice Address - Street 2:BLDG 16, STE 1B
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5420
Practice Address - Country:US
Practice Address - Phone:801-746-7190
Practice Address - Fax:866-284-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8566732-0162261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)