Provider Demographics
NPI:1568296143
Name:GILES, MAYA KATE
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:KATE
Last Name:GILES
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 1:143 E 500 N # 143
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2471
Mailing Address - Country:US
Mailing Address - Phone:435-823-2102
Mailing Address - Fax:
Practice Address - Street 1:244 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3760
Practice Address - Country:US
Practice Address - Phone:435-200-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician