Provider Demographics
NPI:1689389082
Name:GALE-JACKSON, SEREN (ACMHC)
Entity Type:Individual
Prefix:MS
First Name:SEREN
Middle Name:
Last Name:GALE-JACKSON
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:PO BOX 3872
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3872
Mailing Address - Country:US
Mailing Address - Phone:801-521-4227
Mailing Address - Fax:801-359-0777
Practice Address - Street 1:352 S DENVER ST STE 350
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3059
Practice Address - Country:US
Practice Address - Phone:801-521-4227
Practice Address - Fax:801-359-0777
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11090465-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health