Provider Demographics
NPI:1265592083
Name:FENSTER CORP.
Entity type:Organization
Organization Name:FENSTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FENSTERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-201-3139
Mailing Address - Street 1:4505 WASATCH BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4733
Mailing Address - Country:US
Mailing Address - Phone:801-201-3139
Mailing Address - Fax:
Practice Address - Street 1:4505 WASATCH BLVD STE 380
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4733
Practice Address - Country:US
Practice Address - Phone:801-201-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5075655-2501103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty