Provider Demographics
NPI:1063833895
Name:NESS, KENNY
Entity Type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:NESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 200 N
Mailing Address - Street 2:
Mailing Address - City:MONA
Mailing Address - State:UT
Mailing Address - Zip Code:84645
Mailing Address - Country:US
Mailing Address - Phone:435-623-2825
Mailing Address - Fax:435-623-2827
Practice Address - Street 1:619 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1547
Practice Address - Country:US
Practice Address - Phone:801-420-0465
Practice Address - Fax:801-375-4241
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor