Provider Demographics
NPI:1528620341
Name:GATES-LAWRENCE, TORRIE N
Entity type:Individual
Prefix:
First Name:TORRIE
Middle Name:N
Last Name:GATES-LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E 7615 S UNIT UP
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2628
Mailing Address - Country:US
Mailing Address - Phone:801-499-1609
Mailing Address - Fax:
Practice Address - Street 1:51 E 7615 S UNIT UP
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2628
Practice Address - Country:US
Practice Address - Phone:801-499-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician