Healthcare Provider Details

I. General information

NPI: 1417769712
Provider Name (Legal Business Name): KENNETH L HELLMER D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CENTER CHAPLAIN SERVICE (125)
AUGUSTA ME
04330
US

IV. Provider business mailing address

PO BOX 6188
CHINA VILLAGE ME
04926-0188
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-5735
  • Fax:
Mailing address:
  • Phone: 207-595-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2742195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: