Provider Demographics
NPI:1932620531
Name:MARBLE, JONATHAN RAY (ACMHC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAY
Last Name:MARBLE
Suffix:
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 1:6413 W KING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-4212
Mailing Address - Country:US
Mailing Address - Phone:801-808-3283
Mailing Address - Fax:
Practice Address - Street 1:10757 S RIVER FRONT PKWY STE 275
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3548
Practice Address - Country:US
Practice Address - Phone:801-808-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10380215-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health