Provider Demographics
NPI:1528132503
Name:OPENSHAW, D. KIM (PHD, LCSW, LMFT)
Entity type:Individual
Prefix:DR
First Name:D.
Middle Name:KIM
Last Name:OPENSHAW
Suffix:
Gender:M
Credentials:PHD, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SCHIESS CT
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6379
Mailing Address - Country:US
Mailing Address - Phone:435-753-7332
Mailing Address - Fax:435-797-7220
Practice Address - Street 1:295 SCHIESS CT
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6379
Practice Address - Country:US
Practice Address - Phone:435-753-7332
Practice Address - Fax:435-797-7220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114000-35011041C0700X
UT114000-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist