Provider Demographics
NPI:1487990594
Name:NEW BEGINNINGS FAMILY COUNSELING
Entity type:Organization
Organization Name:NEW BEGINNINGS FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-528-7048
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0936
Mailing Address - Country:US
Mailing Address - Phone:435-528-7048
Mailing Address - Fax:435-528-7048
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642-1372
Practice Address - Country:US
Practice Address - Phone:435-528-7048
Practice Address - Fax:435-528-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114076-3501302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000077045Medicare PIN