Active NPI
Kimberly Jensen
- Mental Health Counselor
- South Jordan, UT
National Provider Identifier
1689457756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 11784059-3501
- Practice address
- 1234 W South Jordan Pkwy Ste B2
South Jordan, UT 84095-4649 - Phone
- (801) 821-4501
- NPI assigned
- Aug 14, 2023
- 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 | 11784059-3501 | UT | Primary |
Addresses
Primary practice location
1234 W South Jordan Pkwy Ste B2
South Jordan, UT 84095-4649
Mailing address
7174 S Breeze Hill Rd
West Jordan, UT 84081-3928
Phone (801) 824-8089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 15, 2024 through May 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11784059-3501 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692316800000",
"number": "1689457756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7174 S BREEZE HILL RD",
"city": "WEST JORDAN",
"state": "UT",
"postal_code": "840813928",
"telephone_number": "801-824-8089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1234 W SOUTH JORDAN PKWY STE B2",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840954649",
"telephone_number": "801-821-4501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-14",
"last_updated": "2023-08-18",
"certification_date": "2023-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "11784059-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.