Healthcare Provider Details

I. General information

NPI: 1629358403
Provider Name (Legal Business Name): JAYNE I PATIENCE CPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6138 S 380 W
MURRAY UT
84107-6988
US

IV. Provider business mailing address

6138 S 380 W
MURRAY UT
84107-6988
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-0191
  • Fax: 801-262-4750
Mailing address:
  • Phone: 801-878-0191
  • Fax: 801-262-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: