MEDICARE: JEANNA CUNNINGHAM CMHC

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	7932424-6004	UT

General Provider Information

NPI Number	:	1619445608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNA CUNNINGHAM CMHC

Provider Business Mailing Address
First Line	:	233 S PLEASANT GROVE BLVD STE 201
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-2878
Country	:	US
Telephone Number	:	801-410-0542
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 S PLEASANT GROVE BLVD STE 201
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-2878
Country	:	US
Telephone Number	:	801-410-0542
Fax Number	:

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

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	04/13/2025

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