Provider Demographics
NPI:1376515288
Name:FENNIMORE, DON (LPC)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:FENNIMORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 ELEVENTH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3602
Mailing Address - Country:US
Mailing Address - Phone:801-231-3855
Mailing Address - Fax:801-273-6363
Practice Address - Street 1:4460 HIGHLAND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3543
Practice Address - Country:US
Practice Address - Phone:801-273-6366
Practice Address - Fax:801-273-6363
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1335076004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional