Healthcare Provider Details

I. General information

NPI: 1508221276
Provider Name (Legal Business Name): KENDAL WELLINGTON HUMES LPC, LAC, LIAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 MOHAWK RD
PUEBLO CO
81001-1519
US

IV. Provider business mailing address

226 1/2 S UNION AVE UNIT 210
PUEBLO CO
81003-3557
US

V. Phone/Fax

Practice location:
  • Phone: 719-582-4362
  • Fax:
Mailing address:
  • Phone: 719-582-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001478
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0014468
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: