Healthcare Provider Details

I. General information

NPI: 1922561752
Provider Name (Legal Business Name): KENDRA BLANCO APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA PARKS

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 29TH ST STE 202
LOVELAND CO
80538-2746
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-5170
  • Fax: 970-669-7521
Mailing address:
  • Phone: 970-624-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4822
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016387
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: