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NPI Code Detail

MEDICARE: MR. JEREMY LEE CHRISTENSEN LCSW

MEDICARE: MR. JEREMY LEE CHRISTENSEN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker47819673501UT

General Provider Information

NPI Number : 1205812450
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEREMY LEE CHRISTENSEN LCSW
Provider Business Mailing Address
First Line : 1300 E CENTER ST
Second Line :
City : PROVO
State : UT
Zip : 84606-3554
Country : US
Telephone Number : 801-344-4400
Fax Number :
Provider Business Practice Location Address
First Line : 1300 E CENTER ST
Second Line :
City : PROVO
State : UT
Zip : 84606-3554
Country : US
Telephone Number : 801-344-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 03/14/2023

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