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General NPI Number Information
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NPI Number | 1316047848
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Entity Type | Individual
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Provider Name | TJ GROW CMHC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 151 E 5600 S STE 200
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City | MURRAY
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State | UT
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Zip | 84107-8150
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Country | US
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Telephone | 801-262-5418
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Fax | 801-262-5468
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Provider Business Mailing Address
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Address Line | 151 E 5600 S STE 200
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City | MURRAY
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State | UT
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Zip | 84107-8150
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Country | US
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Telephone | 801-262-5418
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Fax | 801-262-5468
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 30989666004
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License Number State | UT
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