Provider Demographics
NPI:1497767313
Name:THEVENIN, KENNETH EUGENE (LMFT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:THEVENIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E NORTH TEMPLE FL 8
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84150-4412
Mailing Address - Country:US
Mailing Address - Phone:806-401-4661
Mailing Address - Fax:
Practice Address - Street 1:50 E NORTH TEMPLE FL 8
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84150-4412
Practice Address - Country:US
Practice Address - Phone:806-401-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT282730-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist