Healthcare Provider Details

I. General information

NPI: 1124338553
Provider Name (Legal Business Name): JARED R JENSEN CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 W BUSINESS PARK DR
OREM UT
84058-2203
US

IV. Provider business mailing address

1358 W BUSINESS PARK DR
OREM UT
84058-2203
US

V. Phone/Fax

Practice location:
  • Phone: 801-676-8921
  • Fax: 801-208-1987
Mailing address:
  • Phone: 801-676-8921
  • Fax: 801-208-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5081673-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: