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General NPI Number Information
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NPI Number | 1417010190
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Entity Type | Individual
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Provider Name | JARED LANDVATTER CPCI
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 475 W 50 N ALPINE CENTER FOR BEHAVIORAL HEALTH
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City | AMERICAN FORK
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State | UT
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Zip | 84003
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Country | US
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Telephone | 801-756-3664
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Fax |
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Provider Business Mailing Address
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Address Line | 475 W 50 N
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City | AMERICAN FORK
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State | UT
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Zip | 84003
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Country | US
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Telephone | 801-756-3664
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Fax | 701-756-3698
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2702096009
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License Number State | UT
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