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General NPI Number Information
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NPI Number | 1235884644
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Entity Type | Individual
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Provider Name | KENNETH LEE DUNHAM III LPCC
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Gender | Male
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1899 E ROSEVILLE PKWY STE 100
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City | ROSEVILLE
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State | CA
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Zip | 95661-7980
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Country | US
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Telephone | 209-783-8586
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Fax |
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Provider Business Mailing Address
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Address Line | 3102 BEACHCOMBER DR E
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City | ROCKLIN
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State | CA
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Zip | 95677-4783
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Country | US
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Telephone | 209-201-2245
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17944
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License Number State | CA
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