MEDICARE: MRS. JACQUE P. CRAIG CMHC

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	101Y00000X	Counselor	10675382	UT

General Provider Information

NPI Number	:	1538871223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUE P. CRAIG CMHC

Provider Business Mailing Address
First Line	:	15 E SOUTH TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84150-9002
Country	:	US
Telephone Number	:	801-240-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 E SOUTH TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84150-9002
Country	:	US
Telephone Number	:	801-240-4334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2022
Last Update Date	:	12/14/2022

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