Provider Demographics
NPI:1396970141
Name:GILCHRIST, MARC (LSW)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GILCHRIST
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S 100 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6915
Mailing Address - Country:US
Mailing Address - Phone:801-234-9868
Mailing Address - Fax:
Practice Address - Street 1:1173 S 100 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6915
Practice Address - Country:US
Practice Address - Phone:801-234-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health