Provider Demographics
NPI:1750777413
Name:HUNTER, JACQUELINE (CMHC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11087 S TIPPECANOE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4155
Mailing Address - Country:US
Mailing Address - Phone:801-380-2367
Mailing Address - Fax:801-280-0423
Practice Address - Street 1:448 E WINCHESTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7591
Practice Address - Country:US
Practice Address - Phone:801-280-0413
Practice Address - Fax:801-280-0423
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7394845-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health