Active NPI
Myrna Suzanne Gillis, LAMFT
- Marriage & Family Therapist
- Provo, UT
National Provider Identifier
1356778377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 104100000X
- Practice address
- 1726 Buckley Drive
Provo, UT 84606 - Phone
- (801) 373-6562
- Fax
- (801) 375-9225
- NPI assigned
- Oct 4, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 104100000X | UT | Primary |
Addresses
Primary practice location
1726 Buckley Drive
Provo, UT 84606
Mailing address
857 East 200 South
Salt Lake City, UT 84102
Phone (801) 487-3276
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 |
|---|---|---|---|
| 104100000X | UT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485216000000",
"number": "1356778377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "857 EAST 200 SOUTH",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84102",
"telephone_number": "801-487-3276",
"fax_number": "801-467-3725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1726 BUCKLEY DRIVE",
"city": "PROVO",
"state": "UT",
"postal_code": "84606",
"telephone_number": "801-373-6562",
"fax_number": "801-375-9225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "MYRNA",
"middle_name": "SUZANNE",
"credential": "LAMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-04",
"last_updated": "2017-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "UT",
"license": "104100000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.