Provider Demographics
NPI:1851720809
Name:MACEDONE, JAMES HENRY JR (ACMHC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HENRY
Last Name:MACEDONE
Suffix:JR
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 1:1720 N 1900 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3094
Mailing Address - Country:US
Mailing Address - Phone:385-201-7236
Mailing Address - Fax:
Practice Address - Street 1:179 N 1200 E STE 101
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2148
Practice Address - Country:US
Practice Address - Phone:801-806-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-09
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77-0608544171R00000X
UT11841891-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty