Jolene Blackburn, CPCI
Individual provider Active NPI Counselor · Ephraim, UT
NPI 1043330830 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043330830
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 390 W 100 N
Ephraim, UT 84627-2131 - Phone
- (435) 283-4065
- Fax
- (435) 283-5387
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Utah Counseling Center | Counselor | Past | Accepting new patients |
| Central Utah Mental Health Substance Abuse | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
390 W 100 N
Ephraim, UT 84627-2131
Mailing address
255 W Main St
Mount Pleasant, UT 84647-1331
Phone (435) 462-2416
Other providers in Ephraim, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.