Healthcare Provider Details

I. General information

NPI: 1043845746
Provider Name (Legal Business Name): JAYSON CARMONA M.S., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 E DOWNWATER ST
EAGLE MOUNTAIN UT
84005-5123
US

IV. Provider business mailing address

24 W SERGEANT COURT DR STE 201
SARATOGA SPRINGS UT
84045-5809
US

V. Phone/Fax

Practice location:
  • Phone: 385-325-1779
  • Fax:
Mailing address:
  • Phone: 801-341-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105349443904
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10534944-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: