Provider Demographics
NPI:1699169011
Name:LEASURE, KENDYL (CMHC)
Entity type:Individual
Prefix:
First Name:KENDYL
Middle Name:
Last Name:LEASURE
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 S WAINWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1819
Mailing Address - Country:US
Mailing Address - Phone:801-828-6139
Mailing Address - Fax:
Practice Address - Street 1:2605 E 3300 S
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84109-2728
Practice Address - Country:US
Practice Address - Phone:801-828-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8073723-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health