# JACKIE Z ROCK LLC

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

## Provider details

- **NPI number:** 1730785940
- **Authorized official:** JACKIE Z ROCK LCMHC (MENTAL HEALTH COUNSELOR)
- **Authorized official phone:** (801) 448-7811

## Contact information

- **Practice address:** 123 E MAIN ST, SANDY, UT 84070-1509
- **Practice address phone:** (801) 448-7811
- **Mailing address:** 123 E MAIN ST, SANDY, UT 84070-1509
- **Mailing address phone:** (801) 448-7811

## Taxonomy

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

## Other

- **Enumeration date:** 12/11/2020
- **Last updated:** 12/11/2020