1861624033 NPI number — MS. PAMELA K KENNEL MA, LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861624033 NPI number — MS. PAMELA K KENNEL MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEL
Provider First Name:
PAMELA
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861624033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 E ARAPAHOE RD
Provider Second Line Business Mailing Address:
SUITE 242
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-730-1144
Provider Business Mailing Address Fax Number:
303-300-9222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 E ARAPAHOE RD
Provider Second Line Business Practice Location Address:
SUITE 242
Provider Business Practice Location Address City Name:
CENTENNIAL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-730-1144
Provider Business Practice Location Address Fax Number:
303-300-9222
Provider Enumeration Date:
08/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  9554 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 9554 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1508100488 . This is a "NATIONAL PROVIDER ID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com