MEDICARE: JESSICA AURORA BERRIO

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	101YM0800X	Mental Health Counselor	7656912-3501	UT

General Provider Information

NPI Number	:	1548475353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA AURORA BERRIO

Provider Business Mailing Address
First Line	:	10486 N CANTERBURY DR
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-9305
Country	:	US
Telephone Number	:	801-669-6104
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 W BELL RD
Second Line	:	SUITE 21
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8544
Country	:	US
Telephone Number	:	632-878-2037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	12/06/2012

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