Provider Demographics
NPI:1487921722
Name:JORDAN VALLEY COUNSELING CLINIC
Entity type:Organization
Organization Name:JORDAN VALLEY COUNSELING CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DSW
Authorized Official - Phone:801-282-1374
Mailing Address - Street 1:9528 CALEDONIA CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9701
Mailing Address - Country:US
Mailing Address - Phone:801-282-1374
Mailing Address - Fax:801-280-8225
Practice Address - Street 1:9528 CALEDONIA CIR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9701
Practice Address - Country:US
Practice Address - Phone:801-282-1374
Practice Address - Fax:801-280-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10126535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty