Healthcare Provider Details

I. General information

NPI: 1528132503
Provider Name (Legal Business Name): D. KIM OPENSHAW PH.D., LCSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 SCHIESS CT
LOGAN UT
84321-6379
US

IV. Provider business mailing address

295 SCHIESS CT
LOGAN UT
84321-6379
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-7332
  • Fax: 435-797-7220
Mailing address:
  • Phone: 435-753-7332
  • Fax: 435-797-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114000-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114000-3902
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: