# JUDICIAL SUPERVISION SERVICES, LLC

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

## Provider details

- **NPI number:** 1487294252
- **Authorized official:** KARENA Z JACKSON (PROGRAM DIRECTOR)
- **Authorized official phone:** (801) 486-8143

## Contact information

- **Practice address:** 5047 S GALLERIA DR, MURRAY, UT 84123-4695
- **Practice address phone:** (801) 486-8143
- **Practice address fax:** (801) 746-6090
- **Mailing address:** 5047 S GALLERIA DR, MURRAY, UT 84123-4695
- **Mailing address phone:** (801) 486-8143
- **Mailing address fax:** (801) 746-6090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2020
- **Last updated:** 01/09/2020