Basic Information
| Provider Information | |||||||||
| NPI: | 1699912394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHESLEY | ||||||||
| FirstName: | GARRETT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 E 930 S | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840585001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012256246 | ||||||||
| FaxNumber: | 8012251525 | ||||||||
| Practice Location | |||||||||
| Address1: | 1134 N 500 W | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013578310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 379374-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | 103TH0004X | 379374-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TP2701X | 379374-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TC0700X | 379374-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.