Organization
SIDELINE SPORT PSYCHOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOURDAN JOHNSON EDD, LMFT, CMPC (OWNER)
(916) 690-0399
Entity
Organization
Contact information
Practice address
1336 S 1100 E, SALT LAKE CITY, UT 84105-2421
(385) 899-2251
Mailing address
4715 S BRON BRECK ST, HOLLADAY, UT 84117-6403
(916) 690-6482
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/29/2024
Last updated
10/29/2024
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