Provider Demographics
NPI:1437386547
Name:HOLBROOK, JOCELYN ELIZABETH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOCELYN
Middle Name:ELIZABETH
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57162
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-0162
Mailing Address - Country:US
Mailing Address - Phone:801-879-0252
Mailing Address - Fax:801-983-5258
Practice Address - Street 1:5802 S 900 E STE 10
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1644
Practice Address - Country:US
Practice Address - Phone:801-879-0252
Practice Address - Fax:801-983-5258
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X
UT6010892-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)