Kenneth Lake Hennefer, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

116860-3501 Issued in UT

Practice address

7321 S State St
Ste a-B
Midvale, UT 84047-2055

Phone

(801) 352-2844

Fax

(801) 942-1973

NPI assigned

Feb 3, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538207154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 MCNEILL CIR",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840932136",
            "telephone_number": "801-942-1973",
            "fax_number": "801-942-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7321 S STATE ST",
            "address_2": "STE A-B",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472055",
            "telephone_number": "801-352-2844",
            "fax_number": "801-942-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNEFER",
        "first_name": "KENNETH",
        "middle_name": "LAKE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "116860-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Midvale, UT
• Providers in Midvale, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.