Active NPI
Jesse Gora, PSY.D.
- Clinical Psychologist
- Salt Lake City, UT
National Provider Identifier
1386629376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 50251392501
- Practice address
- 1060 E 100 S
Suite 105
Salt Lake City, UT 84102-1501 - Phone
- (801) 532-7414
- NPI assigned
- Dec 13, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 50251392501 | UT | Primary |
Addresses
Primary practice location
1060 E 100 S
Suite 105
Salt Lake City, UT 84102-1501
Mailing address
4659 Brookwood Dr
Salt Lake City, UT 84117-4909
Phone (801) 532-7414
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107029545101 | Other | UT | U006 |
| 8573690 | Other | UT | U002 |
| 942938348015 | Other | UT | U009 |
| Q11013 | Other | UT | ICAR |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50251392501 | UT | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Behavioral Health Incorporated | Clinical | 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 Clinic/Center (Including Community Mental Health Center)
- West Valley City, UT
- NPI 1932166980
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192665600000",
"number": "1386629376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4659 BROOKWOOD DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841174909",
"telephone_number": "801-532-7414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 E 100 S",
"address_2": "SUITE 105",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841021501",
"telephone_number": "801-532-7414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORA",
"first_name": "JESSE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-13",
"last_updated": "2007-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "50251392501",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U006",
"identifier": "107029545101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U002",
"identifier": "8573690",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U009",
"identifier": "942938348015",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICAR",
"identifier": "Q11013",
"state": "UT"
}
],
"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 Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.