Sideline Sport Psychology PLLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SIDELINE SPORT PSYCHOLOGY PLLC

Practice address

1336 S 1100 E
Salt Lake City, UT 84105-2421

Phone

(385) 899-2251

NPI assigned

Oct 29, 2024

Last updated

Oct 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jourdan Johnson, EDD, LMFT, CMPCNPI 1871086140

Title

Owner

Phone

(916) 690-0399

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jourdan Johnson

  • Marriage & Family Therapist
  • Salt Lake City, UT
  • NPI 1871086140
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1053133322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 S BRON BRECK ST",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841176403",
            "telephone_number": "916-690-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 S 1100 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841052421",
            "telephone_number": "385-899-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDELINE SPORT PSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOURDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-690-0399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD, LMFT, CMPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karli Alyn Sibley, PA-C
• Rosa Sibrian
• Anna M Siciliano, M.A, C.C.C., S.L.P.
• McKenzie Marie Sicke, MD
• Philip Jason Siddoway
• Konstantinos Sideris
• Andrew C Sidoli, LMSW, LADAC
• Abbie Lyn Siebenhaar, PAC
• Kimberly Olson Sieber, PH.D.
• Nikki Sieber

• Adult Mental Health Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Adult Mental Health Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.