Jacob Shane Smith, ACMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8519497-6004 Issued in UT

Practice address

3714 E Campus Dr Ste 101
Eagle Mountain, UT 84005-5451

Phone

(801) 789-7780

NPI assigned

Feb 21, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

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 and National Provider Directory roles.

• Triumph Counseling Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eagle Mountain, UT
  • NPI 1114765054
  NPD Authorized official
• Darren J Gillespie LCSW, LLC

  • Clinical Social Worker
  • Eagle Mountain, UT
  • NPI 1356843049
  NPD

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1801541511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2418 E HITCHING POST DR",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840052004",
            "telephone_number": "801-608-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3714 E CAMPUS DR STE 101",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840055451",
            "telephone_number": "801-789-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACOB",
        "middle_name": "SHANE",
        "credential": "ACMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-21",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "8519497-6004",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "8519497-6101",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Lee Simmons, FNP-C
• Jaicee Simpkins
• Christopher Simpson
• Aubrey Slabbert, HCHI HCHD
• SLPD Em, LLC
• Justin Gregory Sommers
• Charles C Southerland, DPM
• Tahsha T Spackman, WHNP-BC
• Lauren Spencer
• Sharon K Sperry, RN

• Mental Health Counselor in Eagle Mountain, UT
• Providers in Eagle Mountain, 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 May 20, 2024; 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.