Healthcare Provider Details

I. General information

NPI: 1831452374
Provider Name (Legal Business Name): JAMES RYAN KENNEDY LP, LAC, LMFT, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 E 33RD AVE
DENVER CO
80207-2112
US

IV. Provider business mailing address

PO BOX 7040
DENVER CO
80207-0040
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-9988
  • Fax: 303-399-9977
Mailing address:
  • Phone: 303-399-9988
  • Fax: 303-399-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5731
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number492
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1570
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number804
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number116891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: