Healthcare Provider Details

I. General information

NPI: 1114841301
Provider Name (Legal Business Name): NATASHA JACOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 170
MURRAY UT
84107-8320
US

IV. Provider business mailing address

4516 S 700 E STE 170
MURRAY UT
84107-8320
US

V. Phone/Fax

Practice location:
  • Phone: 385-275-6268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: