Provider Demographics
NPI:1275426579
Name:HOUGHTALEN, JAIDA MELYNN (SSW)
Entity type:Individual
Prefix:
First Name:JAIDA
Middle Name:MELYNN
Last Name:HOUGHTALEN
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E 700 S STE 3
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4006
Mailing Address - Country:US
Mailing Address - Phone:801-673-1004
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 3
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4006
Practice Address - Country:US
Practice Address - Phone:801-673-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139875243503101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)