Healthcare Provider Details

I. General information

NPI: 1336215706
Provider Name (Legal Business Name): JM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 S HIGHLAND DR STE 210
SALT LAKE CITY UT
84124-2674
US

IV. Provider business mailing address

1612 GREGSON AVE
SALT LAKE CITY UT
84106
US

V. Phone/Fax

Practice location:
  • Phone: 385-399-3696
  • Fax:
Mailing address:
  • Phone: 801-808-2083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5844389-2501
License Number StateUT

VIII. Authorized Official

Name: DR. SCOTT MICHAEL MCAWARD
Title or Position: BILLING MANAGER
Credential: PH.D.
Phone: 801-808-2083