Provider Demographics
NPI:1598294183
Name:BEUS, KELCI WARD
Entity Type:Individual
Prefix:
First Name:KELCI
Middle Name:WARD
Last Name:BEUS
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 1:2727 N WASHINGTON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2276
Mailing Address - Country:US
Mailing Address - Phone:801-710-0421
Mailing Address - Fax:
Practice Address - Street 1:2727 N WASHINGTON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2276
Practice Address - Country:US
Practice Address - Phone:801-710-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10822128-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10822128-6009OtherSTATE OF UTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL & PROFESSIONAL LIC