Provider Demographics
NPI:1053445569
Name:KENRICK, JOSEPH H (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:KENRICK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85358-0487
Mailing Address - Country:US
Mailing Address - Phone:928-684-6714
Mailing Address - Fax:
Practice Address - Street 1:920 S. VULTURE MINE ROAD
Practice Address - Street 2:SPECIAL SERVICES
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390
Practice Address - Country:US
Practice Address - Phone:928-684-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103411OtherAHCCCS PROVIDER NUMBER