Active NPI
Jericho Brent Avery, CSW, CSUDC
- Clinical Social Worker
- American Fork, UT
National Provider Identifier
1649838863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10395960-3501
- Practice address
- 21 E 100 N
American Fork, UT 84003-1651 - Phone
- (385) 374-9708
- NPI assigned
- Jun 3, 2019
- Last updated
- Jul 7, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 Social Worker | 1041C0700X | 10395960-3501 | UT | Primary |
Addresses
Primary practice location
21 E 100 N
American Fork, UT 84003-1651
Mailing address
2214 E Loch Lomond Dr
Saratoga Springs, UT 84043-3911
Phone (385) 374-9708
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 |
|---|---|---|---|
| 10395960-3501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Keys to Mending Therapy and Wellness, PLLC | Clinical | Past | Accepting new patients |
| Reflections Outpatient | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Social Worker
- American Fork, UT
- NPI 1386552529
-
- Substance Abuse Rehabilitation Facility
- Lindon, UT
- NPI 1538672712
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783382400000",
"number": "1649838863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2214 E LOCH LOMOND DR",
"city": "SARATOGA SPRINGS",
"state": "UT",
"postal_code": "840433911",
"telephone_number": "385-374-9708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 E 100 N",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840031651",
"telephone_number": "385-374-9708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVERY",
"first_name": "JERICHO",
"middle_name": "BRENT",
"credential": "CSW, CSUDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-03",
"last_updated": "2026-07-07",
"certification_date": "2026-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "10395960-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in American Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.