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General NPI Number Information
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NPI Number | 1881350106
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Entity Type | Individual
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Provider Name | JARED ALSTON LCMHC
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Gender | Male
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1901 PROSPECTOR AVE
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City | PARK CITY
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State | UT
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Zip | 84060-7320
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Country | US
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Telephone | 435-395-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 60 N 400 W
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City | MIDWAY
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State | UT
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Zip | 84049-6370
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Country | US
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Telephone | 435-395-9494
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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 | 10566496-6004
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License Number State | UT
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