Healthcare Provider Details

I. General information

NPI: 1710226956
Provider Name (Legal Business Name): SUNCREST COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4711
US

IV. Provider business mailing address

1258 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4711
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-1155
  • Fax:
Mailing address:
  • Phone: 801-255-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80827886009
License Number StateUT

VIII. Authorized Official

Name: MR. ROD JEPPSON
Title or Position: OWNER
Credential: LPC
Phone: 801-255-1155