Provider Demographics
NPI:1053562041
Name:DENNISON, MARK A (LCPC, LPC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:DENNISON
Suffix:
Gender:M
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 N 450 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1612
Mailing Address - Country:US
Mailing Address - Phone:801-388-1650
Mailing Address - Fax:801-216-4212
Practice Address - Street 1:3146 N 450 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-1612
Practice Address - Country:US
Practice Address - Phone:801-388-1650
Practice Address - Fax:801-216-4212
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLPC 4790346-6004101YM0800X
KYLPCC 0906101YM0800X
WYLPC 978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health