# MOUNTAINSIDE NEUROTHERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083507818
- **Authorized official:** KIRSTEN JACOBSON (OWNER)
- **Authorized official phone:** (801) 833-7536

## Contact information

- **Practice address:** 1133 N MAIN ST STE 202, LAYTON, UT 84041-4873
- **Practice address phone:** (801) 833-7536
- **Mailing address:** 1133 N MAIN ST STE 400, LAYTON, UT 84041-4800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 05/30/2025
- **Last updated:** 05/30/2025