Healthcare Provider Details

I. General information

NPI: 1043146368
Provider Name (Legal Business Name): JESSICA LORRAINE OTERO LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12427 S PASTURE RD STE 201
RIVERTON UT
84096-5608
US

IV. Provider business mailing address

11583 S HARVEST CREST WAY
SOUTH JORDAN UT
84009-5010
US

V. Phone/Fax

Practice location:
  • Phone: 385-202-6113
  • Fax: 385-271-0305
Mailing address:
  • Phone: 928-699-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13989908-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: