Jessica Dawn Black, ACMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11070400-6009 Issued in UT

Practice address

1576 S 500 W
Suite 102
Bountiful, UT 84010

Phone

(801) 406-9002

NPI assigned

Jul 11, 2019

Last updated

Jul 11, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Holding Space Counseling PLLC

  • Counselor
  • Woods Cross, UT
  • NPI 1053263046
  NPD Authorized official

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1619529500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5398 S 1345 W",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844054000",
            "telephone_number": "801-209-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1576 S 500 W",
            "address_2": "SUITE 102",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "801-406-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JESSICA",
        "middle_name": "DAWN",
        "credential": "ACMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "11070400-6009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Alexandria Bishop, LCSW
• Tyson Bishop, DMD
• Schuyler Michelle Bjork
• Anastasia Black
• Angela Black, CFLE-P
• Nikole Black
• Beaux Morgan Blackburn
• Mark H Blaisdell, D.D.S.
• Minju Blanco
• Audrey Blum

• Mental Health Counselor in Bountiful, UT
• Providers in Bountiful, 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 Jul 11, 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.