Active NPI
Gerald Louis Costley, LCSW
- Mental Health Counselor
- Salt Lake City, UT
National Provider Identifier
1164910089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 128158-3501
- Practice address
- 339 E 3900 S Ste 155
Salt Lake City, UT 84107-1978 - Phone
- (801) 347-0370
- Fax
- (801) 261-3701
- NPI assigned
- Apr 26, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 128158-3501 | UT | Primary |
| Counselor | 101Y00000X | 128158-3501 | UT |
Addresses
Primary practice location
339 E 3900 S Ste 155
Salt Lake City, UT 84107-1978
Mailing address
339 E 3900 S Ste 155
Salt Lake City, UT 84107-1978
Phone (801) 347-0370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128158-3501 | UT | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| De Novo Services LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Institutional Pharmacy
- Salt Lake City, UT
- NPI 1164794434
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577577600000",
"number": "1164910089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "339 E 3900 S STE 155",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841071978",
"telephone_number": "801-347-0370",
"fax_number": "801-261-3701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "339 E 3900 S STE 155",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841071978",
"telephone_number": "801-347-0370",
"fax_number": "801-261-3701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTLEY",
"first_name": "GERALD",
"middle_name": "LOUIS",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-26",
"last_updated": "2019-12-29",
"certification_date": "2019-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "128158-3501",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "UT",
"license": "128158-3501",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.