Provider Demographics
NPI:1104152545
Name:DAVIS, DENEAN PETERSEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DENEAN
Middle Name:PETERSEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 N 600 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-4437
Mailing Address - Country:US
Mailing Address - Phone:435-586-0825
Mailing Address - Fax:435-586-0825
Practice Address - Street 1:136 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2560
Practice Address - Country:US
Practice Address - Phone:435-586-5495
Practice Address - Fax:435-865-8055
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108453-3501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker