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General NPI Number Information
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NPI Number | 1508100488
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Entity Type | Organization
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Legal Business Name | SOUTH DENVER PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 2305 E ARAPAHOE RD SUITE 242
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City | CENTENNIAL
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State | CO
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Zip | 80122-1522
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Country | US
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Telephone | 303-730-1144
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Fax | 303-795-9561
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Provider Business Mailing Address
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Address Line | 4 MEADOWBROOK CIR
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City | LITTLETON
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State | CO
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Zip | 80120-4151
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Country | US
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Telephone | 303-795-9560
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | PAMELA KENNEL
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Credential | MA, LPC
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Telephone | 303-730-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5737
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License Number State | CO
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