Individual
JACOB DASTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
487 E 1000 S STE A, PLEASANT GROVE, UT 84062-3639
(801) 893-6399
Mailing address
487 E 1000 S STE A, PLEASANT GROVE, UT 84062-3639
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13536880
UT
Other
Enumeration date
03/02/2020
Last updated
08/22/2023
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