Healthcare Provider Details

I. General information

NPI: 1932031648
Provider Name (Legal Business Name): KENSHO KAI WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 700 E STE 1H
SALT LAKE CITY UT
84102-2821
US

IV. Provider business mailing address

480 I ST
SALT LAKE CITY UT
84103-3144
US

V. Phone/Fax

Practice location:
  • Phone: 801-604-1145
  • Fax:
Mailing address:
  • Phone: 801-604-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CASSIE LARSEN
Title or Position: DIRECTOR
Credential:
Phone: 801-604-1145