Healthcare Provider Details

I. General information

NPI: 1720131899
Provider Name (Legal Business Name): JENNIFER EDITH JAMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 E. BAMBERGER DRIVE SUITE B PSYCHOLOGICAL ASSESSMENT & TREATMENT SPECIALISTS, INC.
AMERICAN FORK UT
84003
US

IV. Provider business mailing address

814 E. BAMBERGER DRIVE SUITE B PSYCHOLOGICAL ASSESSMENT & TREATMENT SPECIALISTS, INC.
AMERICAN FORK UT
84003
US

V. Phone/Fax

Practice location:
  • Phone: 801-772-0202
  • Fax: 801-772-0139
Mailing address:
  • Phone: 801-772-0202
  • Fax: 801-772-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5912235-3502
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5912235-3501 LCSW
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5912235-3501 LCSW
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5912235-3501 LCSW
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: