Provider Demographics
NPI:1639312382
Name:EVAN T KENISON
Entity Type:Organization
Organization Name:EVAN T KENISON
Other - Org Name:SUNSET COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KENISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-850-2547
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-0751
Mailing Address - Country:US
Mailing Address - Phone:435-850-2547
Mailing Address - Fax:435-843-7438
Practice Address - Street 1:50 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2139
Practice Address - Country:US
Practice Address - Phone:435-485-0254
Practice Address - Fax:435-843-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3099283501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health