Individual
JACOB SHANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACMHC
Contact information
Practice address
3714 E CAMPUS DR STE 101, EAGLE MOUNTAIN, UT 84005-5451
(801) 789-7780
Mailing address
2418 E HITCHING POST DR, EAGLE MOUNTAIN, UT 84005-2004
(801) 608-9301
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8519497-6004
UT
101YM0800X
Mental Health Counselor
8519497-6101
UT
101YM0800X
Mental Health Counselor
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Other
Enumeration date
02/21/2022
Last updated
05/20/2024
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