Provider Demographics
NPI:1609451202
Name:BENNION, JEFFREY STEWART (LAMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:STEWART
Last Name:BENNION
Suffix:
Gender:M
Credentials:LAMFT
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 17227
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-0227
Mailing Address - Country:US
Mailing Address - Phone:801-433-2480
Mailing Address - Fax:
Practice Address - Street 1:5288 COMMERCE DR.
Practice Address - Street 2:STE B-258 #3
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4309
Practice Address - Country:US
Practice Address - Phone:801-930-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT282925-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist