Southworth, Jeremiah

Southworth, Jeremiah is an sole proprietor health care provider with primary practice located at 750 N Freedom Blvd , Provo UT 84601-1677. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Southworth, Jeremiah can be contacted via phone (801) 373-4760.

Contact Information

Primary practice address
750 N Freedom Blvd Provo UT 84601-1677
Phone: (801) 373-4760
Fax: (801) 373-0639
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1104223593
LBN Legal business name Southworth, Jeremiah
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 1st, 2014
Last updated May 7th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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