Provider Demographics
NPI:1629693122
Name:TWITCHELL, JARED BLAINE (ACMHC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:BLAINE
Last Name:TWITCHELL
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2140
Mailing Address - Country:US
Mailing Address - Phone:480-432-6381
Mailing Address - Fax:
Practice Address - Street 1:12397 S 300 E STE 100
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8274
Practice Address - Country:US
Practice Address - Phone:385-900-4020
Practice Address - Fax:801-790-0139
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT311580-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health