MEDICARE: JESSICA E KATZ MS, LMHC, LCMHC, LPC

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	MH13474	FL
2	101YM0800X	Mental Health Counselor	CC04990	MN
3	101YM0800X	Mental Health Counselor	11736106-6004	UT

General Provider Information

NPI Number	:	1790064145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA E KATZ MS, LMHC, LCMHC, LPC

Provider Business Mailing Address
First Line	:	50 W BROADWAY, STE 333, PMB 357717
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2070
Country	:	US
Telephone Number	:	321-458-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 W BROADWAY, STE 333 PMB 357717
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2070
Country	:	US
Telephone Number	:	321-458-5663
Fax Number	:

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

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	10/13/2025

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