Active NPI
Jacqueline Renee Graham, CSW
- Mental Health Counselor
- Salt Lake City, UT
National Provider Identifier
1316916059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2089903502
- Practice address
- 124 S 400 E
Suite 450
Salt Lake City, UT 84111-2135 - Phone
- (801) 326-7444
- Fax
- (801) 783-5559
- NPI assigned
- Mar 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2089903502 | UT | Primary |
Addresses
Primary practice location
124 S 400 E
Suite 450
Salt Lake City, UT 84111-2135
Mailing address
124 S 400 E
Suite 450
Salt Lake City, UT 84111-2135
Phone (801) 326-7444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2089903502 | UT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Service Society of Utah | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Salt Lake City, UT
- NPI 1275595688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285545600000",
"number": "1316916059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 S 400 E",
"address_2": "SUITE 450",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841112135",
"telephone_number": "801-326-7444",
"fax_number": "801-783-5559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 S 400 E",
"address_2": "SUITE 450",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841112135",
"telephone_number": "801-326-7444",
"fax_number": "801-783-5559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "JACQUELINE",
"middle_name": "RENEE",
"credential": "CSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-15",
"last_updated": "2010-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "2089903502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.