MEDICARE: BRAEDEN JENSEN ACMHC

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	14248454-6009	UT

General Provider Information

NPI Number	:	1558201939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAEDEN JENSEN ACMHC

Provider Business Mailing Address
First Line	:	4242 S OTTAWA DR
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-5023
Country	:	US
Telephone Number	:	801-382-8738
Fax Number	:

Provider Business Practice Location Address
First Line	:	10808 S RIVER FRONT PKWY STE 377
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-6200
Country	:	US
Telephone Number	:	801-382-8378
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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