MEDICARE: MR. JAMAL AHMED BARAKAT 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	101YP2500X	Professional Counselor	325010-6004	UT
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U006	OTHER	UT	IHC

General Provider Information

NPI Number	:	1912983446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMAL AHMED BARAKAT LPC

Provider Business Mailing Address
First Line	:	2472 S 300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2895
Country	:	US
Telephone Number	:	801-415-7429
Fax Number	:	801-415-7533

Provider Business Practice Location Address
First Line	:	4460 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3543
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:	801-415-7533

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	01/06/2021

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