Healthcare Provider Details

I. General information

NPI: 1558201939
Provider Name (Legal Business Name): BRAEDEN JENSEN ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10808 S RIVER FRONT PKWY STE 377
SOUTH JORDAN UT
84095-6200
US

IV. Provider business mailing address

4242 S OTTAWA DR
WEST VALLEY CITY UT
84119-5023
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-8378
  • Fax:
Mailing address:
  • Phone: 801-382-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14248454-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: