Holly Pack Squires, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

9162614-3902 Issued in UT

Practice address

1258 W South Jordan Pkwy
Suite 202
South Jordan, UT 84095-4711

Phone

(801) 255-1155

NPI assigned

Oct 13, 2016

Sex

Female

Sole proprietor

Yes

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

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.

• Suncrest Counseling

  • Community/Behavioral Health Agency
  • South Jordan, UT
  • NPI 1902232085
  NPD (past)

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1861942864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1258 W SOUTH JORDAN PKWY",
            "address_2": "SUITE 202",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954711",
            "telephone_number": "801-255-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1258 W SOUTH JORDAN PKWY",
            "address_2": "SUITE 202",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954711",
            "telephone_number": "801-255-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUIRES",
        "first_name": "HOLLY",
        "middle_name": "PACK",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-13",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "9162614-3902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southwest Oral and Facial Surgery Inc
• Michaelle Lei Spears, APRN
• Brandon Christopher Spellen, RN
• Terra Spencer, CSW
• Sports Drug Testing Laboratory, LLC
• Elaine St. James, RN
• St. Mark's South Jordan Family Practice LLC (South Jordan Family Medicine)
• Addison Stagg
• Standard Optical Co
• Joseph Barney Stanford, MD

• Marriage & Family Therapist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Marriage & Family Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.