Healthcare Provider Details

I. General information

NPI: 1316047848
Provider Name (Legal Business Name): TJ GROW CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S STE 200
MURRAY UT
84107-8150
US

IV. Provider business mailing address

151 E 5600 S STE 200
MURRAY UT
84107-8150
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-5418
  • Fax: 801-262-5468
Mailing address:
  • Phone: 801-262-5418
  • Fax: 801-262-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30989666004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: