Jessie Leigh Koltz, PHD,NCC,NCSC,ACMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

12557230-6009 Issued in UT

Practice address

2810 Old Main HL
Logan, UT 84322-2810

Phone

(435) 797-1250

NPI assigned

Apr 5, 2023

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

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

Green means eligible to order or refer.

Specialty

Mental Health Counselor

Education

University of Nevada School of Medicine, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1881389013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 OLD MAIN HL",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843222810",
            "telephone_number": "435-797-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 OLD MAIN HL",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843222810",
            "telephone_number": "435-797-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLTZ",
        "first_name": "JESSIE",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "PHD,NCC,NCSC,ACMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-05",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "12557230-6009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara KLC, M.S. CCC-SLP
• Maria Kleinstaeuber, PHD
• Paul Parkinson Klomp, RPH
• Michael Knoll, BC-HIS
• Emily Kate Knowlton
• Tricia Neeley Kotter, RN
• Christopher Kowalski, M.D.
• Katie Kraus, RDN
• Ashley Kreidermacher, PT, DPT
• Chloe Noel Kronmiller

• Mental Health Counselor in Logan, UT
• Providers in Logan, 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 Apr 5, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.