Provider Demographics
NPI:1447506639
Name:BEAN, KINDRA GAYLE SEALY (LCSW)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:GAYLE SEALY
Last Name:BEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KINDRA
Other - Middle Name:GAYLE
Other - Last Name:SEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1082 E 100 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4973
Mailing Address - Country:US
Mailing Address - Phone:435-994-0754
Mailing Address - Fax:
Practice Address - Street 1:1525 N 200 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2032
Practice Address - Country:US
Practice Address - Phone:435-752-8880
Practice Address - Fax:435-752-8884
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
UT8595126-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool