Provider Demographics
NPI:1215252028
Name:BEVAN, JENNIFER MILLAR (JENNIFER BEVAN CMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MILLAR
Last Name:BEVAN
Suffix:
Gender:F
Credentials:JENNIFER BEVAN CMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BEVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNIFER BEVAN CMHC
Mailing Address - Street 1:4527 S 2300 E
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4446
Mailing Address - Country:US
Mailing Address - Phone:801-272-0762
Mailing Address - Fax:801-274-3411
Practice Address - Street 1:4527 S 2300 E
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4446
Practice Address - Country:US
Practice Address - Phone:801-272-0762
Practice Address - Fax:801-274-3411
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376133-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health