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NPI Code Detail

MEDICARE: KENNETH DENNIS LPC

MEDICARE:   KENNETH  DENNIS  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor5179CO

General Provider Information

NPI Number : 1578716171
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DENNIS LPC
Provider Business Mailing Address
First Line : 1864 WOODMOOR DR STE 202
Second Line :
City : MONUMENT
State : CO
Zip : 80132-7464
Country : US
Telephone Number : 719-321-1976
Fax Number : 866-384-1465
Provider Business Practice Location Address
First Line : 1864 WOODMOOR DR
Second Line :
City : MONUMENT
State : CO
Zip : 80132-9095
Country : US
Telephone Number : 719-321-1876
Fax Number : 866-384-1465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 07/15/2021

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Directions to “ KENNETH DENNIS LPC” Practice Location

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