Provider Demographics
NPI:1255566881
Name:JACKSON-VANN, JAMES TEKULVE (LMFT, CFLE)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TEKULVE
Last Name:JACKSON-VANN
Suffix:
Gender:M
Credentials:LMFT, CFLE
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:TEKULVE
Other - Last Name:MARTIAL-VANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, CFLE
Mailing Address - Street 1:250 W 540 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-6631
Mailing Address - Country:US
Mailing Address - Phone:385-290-7472
Mailing Address - Fax:
Practice Address - Street 1:250 W 540 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6631
Practice Address - Country:US
Practice Address - Phone:385-290-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMF826106H00000X
NV4253-R106H00000X
COMFT.0002259106H00000X
MI4101007287106H00000X
GAMFT001145106H00000X
UT6707480-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist