Healthcare Provider Details

I. General information

NPI: 1669088209
Provider Name (Legal Business Name): JAYDE SCROGGS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N UNIVERSITY PKWY STE 9D
PROVO UT
84604-1595
US

IV. Provider business mailing address

664 S 100 W
MANTI UT
84642-1607
US

V. Phone/Fax

Practice location:
  • Phone: 385-518-0652
  • Fax:
Mailing address:
  • Phone: 208-604-4275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11871316-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11871316-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: