Juliet Pack Tietjen, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

10853173-3902 Issued in UT

Practice address

2150 N Main St Ste 9
Logan, UT 84341-1740

Phone

(435) 554-8647

NPI assigned

Feb 4, 2021

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

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1972195634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 HILLSIDE DR",
            "city": "SMITHFIELD",
            "state": "UT",
            "postal_code": "843352540",
            "telephone_number": "435-760-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 N MAIN ST STE 9",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843411740",
            "telephone_number": "435-554-8647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIETJEN",
        "first_name": "JULIET",
        "middle_name": "PACK",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "10853173-3902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Thorne, PA-C
• Mark Jared Thornley, D.D.S.
• Shellie D Thornley, SLP
• Justin Dane Thornton, D.D.S.
• Lindsay Thunell
• Spencer Tietjen, AU.D.
• Vickie B Tilley, RN, CDE
• Utaifeau Joseph Tilo
• Dylan Rolland Tingey
• Natalie Tippets

• Marriage & Family Therapist in Logan, UT
• Providers in Logan, 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 Feb 4, 2021; 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.