MEDICARE: DR. JAMES RYAN KENNEDY LP, LAC, LMFT, RN

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
1	103TC0700X	Clinical Psychologist	5731	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	492	CO
3	101YP2500X	Professional Counselor	1570	CO
4	106H00000X	Marriage & Family Therapist	804	CO
5	163WP0808X	Psychiatric/Mental Health Registered Nurse	116891	CO

General Provider Information

NPI Number	:	1831452374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RYAN KENNEDY LP, LAC, LMFT, RN

Provider Business Mailing Address
First Line	:	PO BOX 7040
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-0040
Country	:	US
Telephone Number	:	303-399-9988
Fax Number	:	303-399-9977

Provider Business Practice Location Address
First Line	:	5833 E 33RD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-2112
Country	:	US
Telephone Number	:	303-399-9988
Fax Number	:	303-399-9977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	01/25/2023

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