Individual
JAMIE LEIGH BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
Mailing address
850 E 300 S STE 6, SALT LAKE CITY, UT 84102-2332
(018) 618-0852
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
4602
AZ
103TC1900X
Counseling Psychologist
Primary
102501922501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982097127
—
UT
05
—
20504
—
AZ
Enumeration date
03/12/2015
Last updated
08/09/2023
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