Provider Demographics
NPI:1427409853
Name:HANKS, JENNIFER (LCMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HANKS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S 100 E STE 300
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 S 100 E STE 300
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2253
Practice Address - Country:US
Practice Address - Phone:801-382-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2023-05-03
Deactivation Date:2021-02-09
Deactivation Code:
Reactivation Date:2023-04-17
Provider Licenses
StateLicense IDTaxonomies
UT9806463-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health