Provider Demographics
NPI:1023668381
Name:GEORGIO, JESSICA (AMFT, LASUDC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GEORGIO
Suffix:
Gender:F
Credentials:AMFT, LASUDC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4516 S 700 E STE 360
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8317
Mailing Address - Country:US
Mailing Address - Phone:385-231-8387
Mailing Address - Fax:
Practice Address - Street 1:6975 UNION PARK AVE #621
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-477-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10950021-6008101YA0400X
171M00000X
UT10950021-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator