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General NPI Number Information
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NPI Number | 1629693122
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Entity Type | Individual
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Provider Name | JARED BLAINE TWITCHELL ACMHC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 12397 S 300 E STE 100
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City | DRAPER
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State | UT
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Zip | 84020-8274
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Country | US
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Telephone | 385-900-4020
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Fax | 801-790-0139
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Provider Business Mailing Address
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Address Line | 1491 E CENTER ST
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City | SPRINGVILLE
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State | UT
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Zip | 84663-2140
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Country | US
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Telephone | 480-432-6381
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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 | 311580-6004
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License Number State | UT
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