Individual provider · Type 1 NPI

Jeremiah Southworth

Mental Health Counselor · Provo, UT

NPI number 1104223593 Active

Practice location

750 N Freedom Blvd
Provo, UT 84601-1677

Call (801) 373-4760 Map

Fax (801) 373-0639

Specialties and licenses

TaxonomyCodeLicense
Peer Specialist 175T00000XNone listed
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1104223593

Jeremiah Southworth's National Provider Identifier is 1104223593, issued on Dec 1, 2014. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Provo, UT. The record was last updated on May 7, 2020.