Healthcare Provider Details

I. General information

NPI: 1699190587
Provider Name (Legal Business Name): JESSIE HOWES ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E FORT UNION BLVD
MIDVALE UT
84047-1531
US

IV. Provider business mailing address

PO BOX 12842
OGDEN UT
84412-2842
US

V. Phone/Fax

Practice location:
  • Phone: 801-603-2547
  • Fax:
Mailing address:
  • Phone: 801-603-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8888798-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: