Jacilyn Nicole Gray, ACMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11558782-6009 Issued in UT

Practice address

3280 W 3500 S Ste E
West Valley, UT 84119-2668

Phone

(801) 979-1351

NPI assigned

Dec 4, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jacque Nicole Gray Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1104463520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2466 GREEN OAKS DR",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840103134",
            "telephone_number": "801-448-8570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 W 3500 S STE E",
            "city": "WEST VALLEY",
            "state": "UT",
            "postal_code": "841192668",
            "telephone_number": "801-979-1351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JACILYN",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "ACMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "11558782-6009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUE",
            "last_name": "GRAY",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "ACMHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Julia A Hammond

• Mental Health Counselor in West Valley, UT
• Providers in West Valley, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; 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.