Healthcare Provider Details

I. General information

NPI: 1447506639
Provider Name (Legal Business Name): KINDRA GAYLE SEALY BEAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KINDRA GAYLE SEALY LCSW

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N 200 W
LOGAN UT
84341-2032
US

IV. Provider business mailing address

1082 E 100 S
LOGAN UT
84321-4973
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-8880
  • Fax: 435-752-8884
Mailing address:
  • Phone: 435-994-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8595126-3501
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: