Provider Demographics
NPI:1922437177
Name:HORTON, JEFF (CMHC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HORTON
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 W BAGLEY PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5697
Mailing Address - Country:US
Mailing Address - Phone:801-282-1000
Mailing Address - Fax:
Practice Address - Street 1:11576 S STATE ST STE 102A
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7121
Practice Address - Country:US
Practice Address - Phone:801-901-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8563806-6009101YM0800X
UT8563806-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional