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Individual

MR. JAMES TEKULVE JACKSON-VANN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMFT, CFLE

Contact information

Practice address
250 W 540 N, OREM, UT 84057-6631
(385) 290-7472
Mailing address
250 W 540 N, OREM, UT 84057-6631
(385) 290-7472

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
4101007287
MI
106H00000X
Marriage & Family Therapist
4253-R
NV
106H00000X
Marriage & Family Therapist
Primary
6707480-3904
UT
106H00000X
Marriage & Family Therapist
MFT.0002259
CO
106H00000X
Marriage & Family Therapist
MFT001145
GA
106H00000X
Marriage & Family Therapist
TPMF826
FL

Other

Enumeration date
05/27/2009
Last updated
11/06/2023
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