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General NPI Number Information
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NPI Number | 1154021129
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Entity Type | Individual
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Provider Name | TIMOTHY BRYSON JINDRA CMHC
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Gender | Male
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 721 N 530 E
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City | OREM
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State | UT
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Zip | 84097-4105
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Country | US
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Telephone | 801-358-0967
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Fax |
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Provider Business Mailing Address
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Address Line | 8193 S 1330 E
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City | SANDY
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State | UT
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Zip | 84093-6611
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Country | US
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Telephone | 801-891-8277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7025125-6004
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License Number State | UT
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