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General NPI Number Information
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NPI Number | 1023077062
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Entity Type | Individual
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Provider Name | DENISE MARIE BOELENS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 5801 FASHION BLVD SUITE 250
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City | MURRAY
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State | UT
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Zip | 84107-6159
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Country | US
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Telephone | 801-596-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 FASHION BLVD SUITE 250
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City | MURRAY
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State | UT
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Zip | 84107-6159
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Country | US
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Telephone | 801-596-0147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 110944-2501
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License Number State | UT
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