Provider Demographics
NPI:1962912501
Name:BROWN, JACOB GRANT (CMHC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:GRANT
Last Name:BROWN
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 1:2997 S RED PINE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4817
Mailing Address - Country:US
Mailing Address - Phone:801-477-6257
Mailing Address - Fax:
Practice Address - Street 1:2997 S RED PINE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-4817
Practice Address - Country:US
Practice Address - Phone:801-477-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16935101YM0800X
UT10540388-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health