Provider Demographics
NPI:1679865000
Name:GILL, NOEL CARSON (PHD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:CARSON
Last Name:GILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 N 1000 W
Mailing Address - Street 2:STE 107
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3130
Mailing Address - Country:US
Mailing Address - Phone:435-753-1556
Mailing Address - Fax:435-753-1556
Practice Address - Street 1:642 N 1000 W
Practice Address - Street 2:STE 107
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3130
Practice Address - Country:US
Practice Address - Phone:435-753-1556
Practice Address - Fax:435-753-1556
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109932-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical