Jacob Eugene Jacquez, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7915180-3501 Issued in UT

Practice address

5814 S 900 E
Murray, UT 84121-1644

Phone

(385) 800-3272

Fax

(385) 800-3260

NPI assigned

Aug 30, 2011

Last updated

Dec 6, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

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.

• Empowering Relief Counseling, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Murray, UT
  • NPI 1548796931
  Authorized official Same address or phone
• Jacquez Counseling, PLLC

  • Adult Mental Health Clinic/Center
  • Murray, UT
  • NPI 1417716382
  NPD (past) Authorized official
• Psychological Preventative Health PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Idaho Falls, ID
  • NPI 1649808767
  NPD

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1841571353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5814 S 900 E",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841211644",
            "telephone_number": "801-548-9696",
            "fax_number": "385-800-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5814 S 900 E",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841211644",
            "telephone_number": "385-800-3272",
            "fax_number": "385-800-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUEZ",
        "first_name": "JACOB",
        "middle_name": "EUGENE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-30",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WY",
            "license": "LCSW-871",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013199",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "4671239",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "7915180-3501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025579",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Christopher Jacobs Jr., MD
• John M Jacobs, M.D.
• Natasha Jacobson
• A Alexander Jacoby, M.D.
• Jacquez Counseling, PLLC
• Solomon Jakomino
• James R.M. Pearce M.D., LLC
• Brooke James, RDN
• Gretchen James, LCSW
• Ashley Brooke Jamsa, PA-S

• Clinical Social Worker in Murray, UT
• Providers in Murray, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.