Healthcare Provider Details

I. General information

NPI: 1265114193
Provider Name (Legal Business Name): J&D ASSOCIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 10/08/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 S HIGHLAND DR STE 220
SALT LAKE CITY UT
84121-3789
US

IV. Provider business mailing address

PO BOX 271351
SALT LAKE CITY UT
84127-1351
US

V. Phone/Fax

Practice location:
  • Phone: 801-718-9186
  • Fax:
Mailing address:
  • Phone: 801-718-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN WEBB
Title or Position: MEMBER
Credential:
Phone: 801-718-9186