Healthcare Provider Details

I. General information

NPI: 1871220772
Provider Name (Legal Business Name): DANIEL JUSTIN ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-8847
US

IV. Provider business mailing address

1320 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-8847
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-9700
  • Fax:
Mailing address:
  • Phone: 801-254-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number142643036009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: