Provider Demographics
NPI:1639256555
Name:KENCE, OZLEM NURAN (LCSW)
Entity Type:Individual
Prefix:
First Name:OZLEM
Middle Name:NURAN
Last Name:KENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 SIDEWINDER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7258
Mailing Address - Country:US
Mailing Address - Phone:435-649-8347
Mailing Address - Fax:
Practice Address - Street 1:1753 SIDEWINDER DRIVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7322
Practice Address - Country:US
Practice Address - Phone:435-649-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3092382-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT30923873500001OtherBLUE CROSS BLUE SHIELD