Provider Demographics
NPI:1073823050
Name:KINNAMAN, JOYCE ELLEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ELLEN
Last Name:KINNAMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JOYCE
Other - Middle Name:ELLEN
Other - Last Name:APGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16832 BUFFALO VALLEY PATH
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7172
Mailing Address - Country:US
Mailing Address - Phone:719-331-5063
Mailing Address - Fax:719-481-0304
Practice Address - Street 1:4785 GRANBY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3131
Practice Address - Country:US
Practice Address - Phone:719-331-5063
Practice Address - Fax:719-481-0304
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional