MEDICARE: GINGER GROVE COLLECTIVE

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396695300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINGER GROVE COLLECTIVE

Provider Business Mailing Address
First Line	:	489 W SOUTH JORDAN PKWY STE 216
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3980
Country	:	US
Telephone Number	:	801-871-5968
Fax Number	:	385-715-4702

Provider Business Practice Location Address
First Line	:	489 W SOUTH JORDAN PKWY STE 216
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3980
Country	:	US
Telephone Number	:	801-871-5968
Fax Number	:	385-715-4702

Authorized Official
Title or Position	:	OWNER
Name	:	ANNELISE PARKER MURPHY
Credential	:	CMHC
Telephone Number	:	801-871-5968

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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