Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2314 | CO |
Y | 101YM0800X | Mental Health Counselor | 2130 | CO |
NPI | 1003094806 |
---|---|
Provider Name | Keith Reid Kendall |
First Address | Lakewood, CO 80228-1120 |
Second Address | Denver, CO 80209-4198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 04/02/2008 |