Basic Information
| Provider Information | |||||||||
| NPI: | 1952651804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARELA | ||||||||
| FirstName: | ALBERTO | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1730 E 3100 N STE 2 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840402408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015254645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1730 E 3100 N STE 2 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840402408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015254645 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 11316073-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.