Provider Demographics
NPI:1649585035
Name:JENNIFER SQUIRE PC
Entity Type:Organization
Organization Name:JENNIFER SQUIRE PC
Other - Org Name:CENTER FOR CHRISTIAN THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-808-2410
Mailing Address - Street 1:7084 S 2300 E
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3968
Mailing Address - Country:US
Mailing Address - Phone:801-808-2410
Mailing Address - Fax:
Practice Address - Street 1:7084 S 2300 E
Practice Address - Street 2:SUITE 140
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3968
Practice Address - Country:US
Practice Address - Phone:801-808-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTC6715627251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health