Individual
JESSICA DAWN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACMHC
Contact information
Practice address
1576 S 500 W, SUITE 102, BOUNTIFUL, UT 84010
(801) 406-9002
Mailing address
5398 S 1345 W, RIVERDALE, UT 84405-4000
(801) 209-1212
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11070400-6009
UT
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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