BRUCE K JACOBSON PH D P C (NPI# 1417913575) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417913575 |
| Entity Type | Organization |
| Organization Name | BRUCE K JACOBSON PH D P C |
| Practice Address |
4190 Highland Dr Suite 211 Salt Lake City UT 84124-2600 |
| Practice Telephone | 8012720614 |
| Practice Fax Number | 8012720678 |
| Mailing Telephone | 8012720614 |
| Mailing Fax Number | 8012720678 |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2018-03-16 |
| Authorized Official Name | BRUCE K JACOBSON (PRESIDENT AND PSYCHOLOGIST) |
| Authorized Official Telephone | 8012720614 |
| Authorized Official Credential | PH D P C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
1162592501 | UT | Ambulatory Health Care Facilities |
| Street Address |
4190 HIGHLAND DR SUITE 211 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84124-2600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598742231 | Kathleen Stroman King | Psychologist | 4190 Highland Dr, Suite 210, Salt Lake City, UT 84124-2600 | 2005-12-23 |
| 1740562123 | Michael Bryce Warner | Dentist | 4190 Highland Dr, Salt Lake City, UT 84124-2600 | 2011-09-13 |
| 1417270323 | Douglas Burgoyne | Pharmacist | 4190 Highland Dr, Suite 250, Salt Lake City, UT 84124-2600 | 2010-03-05 |
| 1679743009 | Bruce Kenneth Jacobson | Psychologist | 4190 Highland Dr, Suite 211, Salt Lake City, UT 84124-2600 | 2008-02-29 |
| 1467678938 | Grant B. Cannon | Dentist | 4190 Highland Dr, Suite 112, Salt Lake City, UT 84124-2600 | 2007-04-17 |
| 1396873279 | Linda C Gurrister | Social Worker | 4190 Highland Dr, Suite 210, Salt Lake City, UT 84124-2600 | 2007-03-01 |
| 1578605143 | Janice Lynn Marcus | Counselor | 4190 Highland Dr, Salt Lake City, UT 84124-2600 | 2007-02-12 |
| 1548329964 | Jeffrey Ralph Grant | Social Worker | 4190 Highland Dr, Suite 210, Salt Lake City, UT 84124-2600 | 2006-12-08 |
| 1578506697 | Jan Ellen Kaderabek Burton | Psychologist | 4190 Highland Dr, Salt Lake City, UT 84124-2600 | 2006-06-14 |
| 1518934744 | Karl E Seashore | Counselor | 4190 Highland Dr, Suite 211, Salt Lake City, UT 84124-2600 | 2006-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487273298 | Shannon Penny Price | Social Worker | 4465 Maybeck Place, Condo C, Millcreek, UT 84124 | 2020-04-11 |
| 1922654367 | Joseph C Melvin Md PC | Colon & Rectal Surgery | 1250 East 3900 South Ste 320, Salt Lake City, UT 84124 | 2019-08-12 |
| 1366923252 | Melanie Stumpf | Counselor | 1141 E 3900, Suite A170, Salt Lake City, UT 84124 | 2018-08-28 |
| 1376033993 | Michelle Flowers | Speech-Language Pathologist | 2120 East 3900 South, Ste 200, Holladay, UT 84124 | 2018-05-18 |
| 1740797257 | Lissa Anne Hutchings | Nurse Practitioner | 1160 E 3900 S Ste 4100, Salt Lake City, UT 84124 | 2018-01-05 |
| 1316465693 | Randy Gines | Counselor | 4460 S Highland Drive # 230, Murray, UT 84124 | 2017-09-06 |
| 1417470717 | Joshua Chandler Spencer | Counselor | 4460 South Highland Dr., 230, Murray, UT 84124 | 2017-07-19 |
| 1659891554 | Marcus Whitney | Counselor | 4460 S Highland Dr. # 230, Murray, UT 84124 | 2017-06-21 |
| 1518496884 | Courtney Nilson | Counselor | 4460 S. Highland Dr. #230, Murray, UT 84124 | 2017-06-08 |
| 1841687126 | Intrafilrx | Preferred Provider Organization | 3920 S 1100 E Ste 210, Salt Lake City, UT 84124 | 2015-04-23 |
| Find all providers in zip 84124 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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| 1194223867 | Cottonwood Behavioral Counseling LLC | Clinic/Center | 6337 S Highland Dr # 227 Suite 227, Salt Lake City, UT 84121-8558 | 2018-01-29 |
| 1336533348 | Salt Lake Weight Counseling | Clinic/Center | 7105 S. Highland Dr. Ste 202, Salt Lake City, UT 84121 | 2015-03-27 |
| 1760576698 | Lds Family Services | Clinic/Center | 132 S State St Ste 100, Salt Lake City, UT 84111-1506 | 2006-10-03 |
| 1568084739 | Utah Zion Healing | Clinic/Center | 2870 E 3300 S, Salt Lake City, UT 84109-2821 | 2020-05-11 |
| 1467002253 | Audrey Maya Wadhwani | Clinic/Center | 500 Foothill Dr, Salt Lake City, UT 84148-0001 | 2019-09-13 |
| 1922570266 | Ihc Health Services Inc | Clinic/Center | 324 E 10th Ave Ste 178, Salt Lake City, UT 84103-2885 | 2018-12-27 |
| 1881109544 | Jordan Rullo LLC | Clinic/Center | 1433 S 1100 E, Salt Lake City, UT 84105-2434 | 2017-12-04 |
| 1023461415 | Alpine Center for Personal Growth | Clinic/Center | 5689 S Redwood Rd, Suite 30, Salt Lake City, UT 84123-5447 | 2016-07-20 |
| 1528413531 | University of Utah Pediatric Behavioral Health Services | Clinic/Center | 501 S Chipeta Way, Salt Lake City, UT 84108-1222 | 2016-04-27 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.