Provider Demographics
NPI:1154021129
Name:JINDRA, TIMOTHY BRYSON (CMHC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRYSON
Last Name:JINDRA
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8193 S 1330 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6611
Mailing Address - Country:US
Mailing Address - Phone:801-891-8277
Mailing Address - Fax:
Practice Address - Street 1:721 N 530 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4105
Practice Address - Country:US
Practice Address - Phone:801-358-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7025125-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health