Provider Demographics
NPI:1821972639
Name:JAY, DAVID PATRICK (SUDC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PATRICK
Last Name:JAY
Suffix:
Gender:M
Credentials:SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 S 500 E APT C204
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4533
Mailing Address - Country:US
Mailing Address - Phone:435-315-6645
Mailing Address - Fax:
Practice Address - Street 1:100 N JOHNSON MILL RD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-6764
Practice Address - Country:US
Practice Address - Phone:866-400-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12331137-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)