Provider Demographics
NPI:1518187798
Name:DENISON, FRED H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:H
Last Name:DENISON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84028-0328
Mailing Address - Country:US
Mailing Address - Phone:435-946-3660
Mailing Address - Fax:
Practice Address - Street 1:325 WEST LOGAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:UT
Practice Address - Zip Code:84028
Practice Address - Country:US
Practice Address - Phone:435-946-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5357-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT810587644001Medicaid
UT810587644001Medicaid