=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821078122
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENT A. TOMPKINS LPC (C0)
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2006
-----------------------------------------------------
Last Update Date | 12/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2216 SCOTCH PINE CT
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-626-3333
-----------------------------------------------------
Fax | 970-776-8124
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2216 SCOTCH PINE CT
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-626-3333
-----------------------------------------------------
Fax | 970-776-8124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 949
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------