NPIMap

Gary Tyler Lefevor, PHD

Individual provider Active NPI Counseling Psychologist · Logan, UT

NPI 1477091650 · NPPES record last updated Mar 13, 2024

Key facts

NPI
1477091650
Entity type
Individual (NPI type 1)
Primary specialty
Counseling Psychologist 103TC1900X
License
11642799-2501 (UT)
Practice address
6405 Old Main Hill
Logan, UT 84322-1624
Phone
(435) 797-3401
Fax
(844) 308-5865
NPI assigned
Feb 7, 2017
Sex
Male
Sole proprietor
No

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Nov 13, 2024 through Nov 13, 2026

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
11642799-2501UTMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Utah State University Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X
Counseling Psychologist 103TC1900X 11642799-2501 UT Yes

Addresses

Primary practice location

6405 Old Main Hill
Logan, UT 84322-1624

Mailing address

6405 Old Main Hill
Logan, UT 84322-6405
Phone (435) 797-3401

Other providers in Logan, UT

All providers in Logan, UT · Counseling Psychologist in Utah

Sources for this page

Verify at the official NPI Registry.