Basic Information
| Provider Information | |||||||||
| NPI: | 1396896858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINIKINI | ||||||||
| FirstName: | KARSON | ||||||||
| MiddleName: | SATEKI | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CMHC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 498 N 900 W STE 200 | ||||||||
| Address2: | |||||||||
| City: | KAYSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840374153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015254645 | ||||||||
| FaxNumber: | 8017797808 | ||||||||
| Practice Location | |||||||||
| Address1: | 498 N 900 W STE 200 | ||||||||
| Address2: | |||||||||
| City: | KAYSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840374153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015254645 | ||||||||
| FaxNumber: | 8017797808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 376686-6009 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.