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Organization
EMPOWERED MIND
Active
Organization
EMPOWERED MIND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILEE JACKSON LCSW (OWNER)
(801) 896-3260
Entity
Organization
Contact information
Practice address
4640 S 3900 W, ROY, UT 84067-8707
(801) 896-3260
Mailing address
4640 S 3900 W, ROY, UT 84067-8707
(801) 963-2608
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8914131-3501
LICENSED CLINICAL SOCIAL WORKER
UT
Enumeration date
02/13/2023
Last updated
05/16/2023
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