Active NPI
Jeremy Jensen
- Mental Health Counselor
- Castle Dale, UT
National Provider Identifier
1992255848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 11450229-6009
- Practice address
- 45 E. 100 S.
Castledale, UT 84513 - Phone
- (435) 381-2432
- Fax
- (801) 373-0639
- NPI assigned
- Oct 4, 2016
- Last updated
- Jun 11, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | ||
| Mental Health Counselor | 101YM0800X | 11450229-6009 | UT | Primary |
Addresses
Primary practice location
45 E. 100 S.
Castledale, UT 84513
Mailing address
P.O. Box 867
Price, UT 84501-0867
Phone (435) 637-7200
Other practice location 1
1258 High St
Eugene, OR 97401-3238
Phone (541) 242-2937
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11450229-6009 | UT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four Corners Community Behavioral Health, Inc. | Current | Accepting new patients | |
| Four Corners Community Behavioral Health Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Price, UT
- NPI 1487715330
-
dba Operation Recovery
- Methadone Clinic
- Price, UT
- NPI 1164048492
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623369600000",
"number": "1992255848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 867",
"city": "PRICE",
"state": "UT",
"postal_code": "845010867",
"telephone_number": "435-637-7200",
"fax_number": "801-373-0639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 E. 100 S.",
"city": "CASTLEDALE",
"state": "UT",
"postal_code": "84513",
"telephone_number": "435-381-2432",
"fax_number": "801-373-0639"
}
],
"practiceLocations": [
{
"address_1": "1258 High St",
"address_purpose": "LOCATION",
"city": "Eugene",
"state": "OR",
"postal_code": "974013238",
"country_code": "US",
"telephone_number": "541-242-2937",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JENSEN",
"first_name": "JEREMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-04",
"last_updated": "2021-06-11",
"certification_date": "2021-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "11450229-6009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Castle Dale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.