Provider Demographics
NPI:1669088209
Name:SCROGGS, JAYDE (LMFT)
Entity type:Individual
Prefix:
First Name:JAYDE
Middle Name:
Last Name:SCROGGS
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 S 100 W
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-1607
Mailing Address - Country:US
Mailing Address - Phone:208-604-4275
Mailing Address - Fax:
Practice Address - Street 1:2230 N UNIVERSITY PKWY STE 9D
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1595
Practice Address - Country:US
Practice Address - Phone:385-518-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11871316-3904106H00000X
UT11871316-3902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist