Provider Demographics
NPI:1043886757
Name:JACOBSON, TAWNI (ACMHC)
Entity Type:Individual
Prefix:
First Name:TAWNI
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 E OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-7211
Mailing Address - Country:US
Mailing Address - Phone:702-807-0377
Mailing Address - Fax:
Practice Address - Street 1:1933 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1044
Practice Address - Country:US
Practice Address - Phone:801-683-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8896415-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health