NPIMap

Organization Active NPI

Jennifer Fairbourn LMFT, LLC

Doing business as Cottonwood Creek Counseling

  • Mental Health Counselor
  • Midvale, UT
National Provider Identifier
1356826036
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
JENNIFER FAIRBOURN LMFT, LLC
Doing business as
Cottonwood Creek Counseling
Practice address
7321 S State St Ste a
Midvale, UT 84047-6105
Phone
(801) 878-4327
Fax
(801) 878-9280
NPI assigned
Sep 28, 2018
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Ms. Jennifer Fairbourn, MSNPI 1992977383
Title
LMFT
Phone
(801) 878-4327

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

7321 S State St Ste a
Midvale, UT 84047-6105

Mailing address

7321 S State St Ste a
Midvale, UT 84047-6105
Phone (801) 878-4327

Other names 1

  • Cottonwood Creek Counseling Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Jen@CWCreek.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220719002188 UT Part B Supplier - Clinic/Group Practice 5294116455 Receives reassigned benefits from 10 practitioners
Practice locations: Midvale, UT

National Provider Directory

National Provider Directory

Locations

7321 S State St
Midvale, UT 84047
Phone (801) 231-6493

7321 S State St
Ste A
Midvale, UT 84047
Phone (801) 878-4327

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1356826036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7321 S STATE ST STE A",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840476105",
            "telephone_number": "801-878-4327",
            "fax_number": "801-878-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7321 S STATE ST STE A",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840476105",
            "telephone_number": "801-878-4327",
            "fax_number": "801-878-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER FAIRBOURN LMFT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-28",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "FAIRBOURN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "LMFT",
        "authorized_official_telephone_number": "801-878-4327",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jen@CWCreek.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7321 S State St Ste A",
            "city": "Midvale",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840476105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cottonwood Creek Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.