Healthcare Provider Details

I. General information

NPI: 1750243879
Provider Name (Legal Business Name): KAIN ELLIS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 THREE SPRINGS BLVD
DURANGO CO
81301-9033
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-317-1930
  • Fax:
Mailing address:
  • Phone: 970-317-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0021141
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: