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233 South Pleasant Grove Blvd Suite 203 Pleasant Grove UT 84062 | |
| (801) 785-4622 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 233 South Pleasant Grove Blvd, Pleasant Grove, Utah |
| Authorized Official Name and Position | Geret Nolan Giles (OWNER) |
| Authorized Official Contact | 8017854622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
762 W 2410 N Pleasant Grove UT 84062-8830 Ph: (801) 785-4622 | 233 South Pleasant Grove Blvd Suite 203 Pleasant Grove UT 84062 Ph: (801) 785-4622 |
| NPI Number | 1427205764 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 07/26/2023 |
| Certification Date | 07/26/2023 |
| Medicare PECOS PAC ID | 8224491733 |
|---|---|
| Medicare Enrollment ID | O20230831001544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427205764 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 334087-2501 (Utah) | Primary |
| Provider Name | Thomas A Rayner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194008979 PECOS PAC ID: 0941533574 Enrollment ID: I20220808003003 |
| Provider Name | Alex J Mageno |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538727284 PECOS PAC ID: 9032586722 Enrollment ID: I20230629003702 |
| Provider Name | Geret Nolan Giles |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073656427 PECOS PAC ID: 1951764463 Enrollment ID: I20230831001665 |
| Provider Name | Dillon Harper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467287524 PECOS PAC ID: 3173064573 Enrollment ID: I20240925004139 |
| Provider Name | Rebecca Lynn Gardiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588223622 PECOS PAC ID: 8820529662 Enrollment ID: I20241003001220 |
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