MEDICARE: JM COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	5844389-2501	UT

General Provider Information

NPI Number	:	1336215706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JM COUNSELING LLC

Provider Business Mailing Address
First Line	:	1612 GREGSON AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106
Country	:	US
Telephone Number	:	801-808-2083
Fax Number	:

Provider Business Practice Location Address
First Line	:	4190 S HIGHLAND DR
Second Line	:	STE 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2674
Country	:	US
Telephone Number	:	385-399-3696
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	DR. SCOTT MICHAEL MCAWARD
Credential	:	PH.D.
Telephone Number	:	801-808-2083

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/19/2023

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