Provider Demographics
NPI:1003424466
Name:PRICE, KENZINGTON (LPC)
Entity Type:Individual
Prefix:
First Name:KENZINGTON
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 E IRON EAGLE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6868
Mailing Address - Country:US
Mailing Address - Phone:208-938-2836
Mailing Address - Fax:208-938-2897
Practice Address - Street 1:1159 E IRON EAGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6868
Practice Address - Country:US
Practice Address - Phone:208-938-2836
Practice Address - Fax:208-938-2897
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC7675101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor