Healthcare Provider Details

I. General information

NPI: 1598685380
Provider Name (Legal Business Name): JAMIE LAFONTAINE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 150
SALT LAKE CITY UT
84107-8317
US

IV. Provider business mailing address

4516 S 700 E STE 150
SALT LAKE CITY UT
84107-8317
US

V. Phone/Fax

Practice location:
  • Phone: 801-882-7149
  • Fax:
Mailing address:
  • Phone: 801-882-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14241705-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: