Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jeremiah Southworth

Individual provider Peer Specialist · NPI 1104223593

Jeremiah Southworth is a Peer Specialist in Provo, Utah. Practices as a sole proprietor. Registered with an NPI since 2014.

In the registry since
2014
Specialties on file
2
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Practice location Address checks out

750 N Freedom Blvd
Provo, UT 84601-1677
Phone: (801) 373-4760
Fax: (801) 373-0639
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X
Peer Specialist Taxonomy 175T00000X

Record details

NPI number1104223593
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 1, 2014
Last updated in NPPESMay 7, 2020
Certification dateMay 7, 2020

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