JACOB DAVID VANWAGONER
NPI 1699087718
Counselor in Provo, UT

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101Y00000X.

Active since July 06, 2010

836 N 1375 W, PROVO, UT 84604(801) 375-2523 Get Directions Write a Review

NPPES record last updated: July 6, 2010. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Jacob David Vanwagoner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB DAVID VANWAGONER (NPI 1699087718) is an individual counselor in Provo, Utah and active in the NPI registry since July 2010.

NPPES Registry Identity

NPI1699087718

Entity TypeIndividualMale

Primary Taxonomy101Y00000X

Provider Legal NameJACOB DAVID VANWAGONER

Location Address836 N 1375 WProvo, UT 84604-3049

Mailing Address836 N 1375 WProvo, UT 84604-3049

Phone(801) 375-2523

Sole ProprietorYes

Enumeration DateJuly 6, 2010

✔ NPI 1699087718 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

836 N 1375 W, Provo, UT 84604

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