Healthcare Provider Details

I. General information

NPI: 1922919653
Provider Name (Legal Business Name): JARED GARY MOSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E 3300 S
MILLCREEK UT
84106-2522
US

IV. Provider business mailing address

1208 E 3300 S
MILLCREEK UT
84106-2522
US

V. Phone/Fax

Practice location:
  • Phone: 801-483-1600
  • Fax:
Mailing address:
  • Phone: 801-483-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13531076-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: