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General NPI Number Information
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NPI Number | 1730002866
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Entity Type | Individual
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Provider Name | JORDAN ANDREW BOYACK
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Gender | Male
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 172 E 14075 S STE 110
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City | DRAPER
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State | UT
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Zip | 84020-5725
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Country | US
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Telephone | 801-899-0732
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Fax |
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Provider Business Mailing Address
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Address Line | 4137 S 900 E APT A
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City | MILLCREEK
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State | UT
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Zip | 84124-1284
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Country | US
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Telephone |
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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 | 14293543-6009
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License Number State | UT
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