Healthcare Provider Details

I. General information

NPI: 1497304521
Provider Name (Legal Business Name): JENNIFER LONGMORE CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER GANNON/BUTLER

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 9000 S # 204
SANDY UT
84070-2008
US

IV. Provider business mailing address

57 W 9000 S # 204
SANDY UT
84070-2008
US

V. Phone/Fax

Practice location:
  • Phone: 801-893-7168
  • Fax: 651-925-0057
Mailing address:
  • Phone: 801-893-7168
  • Fax: 651-925-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11550361-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: