MEDICARE: THEORY AND METHOD THERAPY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790386233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEORY AND METHOD THERAPY COLLECTIVE

Provider Business Mailing Address
First Line	:	3724 LAKESIDE DR STE 200
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-5293
Country	:	US
Telephone Number	:	775-895-0712
Fax Number	:	775-375-1292

Provider Business Practice Location Address
First Line	:	275 E SOUTH TEMPLE STE 103
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1323
Country	:	US
Telephone Number	:	775-895-0712
Fax Number	:	775-375-1292

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA CHRISTINE JENKINS
Credential	:	LCSW
Telephone Number	:	425-359-3557

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	02/02/2026

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