Healthcare Provider Details

I. General information

NPI: 1871220772
Provider Name (Legal Business Name): DANIEL JUSTIN ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 N RIVER RUN DR STE 350
PROVO UT
84604-7708
US

IV. Provider business mailing address

5314 N RIVER RUN DR STE 350
PROVO UT
84604-7708
US

V. Phone/Fax

Practice location:
  • Phone: 801-787-9855
  • Fax:
Mailing address:
  • Phone: 801-787-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number142643036009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: