Provider Demographics
NPI:1457024093
Name:SMITH, JEREMIAH (CSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 LAGUNA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7545
Mailing Address - Country:US
Mailing Address - Phone:435-229-4690
Mailing Address - Fax:
Practice Address - Street 1:51 E 800 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1210
Practice Address - Country:US
Practice Address - Phone:962-343-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10118675-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health