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General NPI Number Information
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NPI Number | 1194361345
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Entity Type | Individual
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Provider Name | BRENDON MICHAEL KERTON M.A., LPC, LAC
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Gender | Male
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 811 MAIN CT
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City | CARBONDALE
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State | CO
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Zip | 81623-1851
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Country | US
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Telephone | 970-704-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 WHEEL CIR
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City | CARBONDALE
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State | CO
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Zip | 81623-1573
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Country | US
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Telephone | 603-498-1166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC.0013230
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License Number State | CO
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