Provider Demographics
NPI:1083496574
Name:WORTHY, KENNETH E II
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:WORTHY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S 167TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4569
Mailing Address - Country:US
Mailing Address - Phone:623-980-8107
Mailing Address - Fax:
Practice Address - Street 1:603 S 167TH DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4569
Practice Address - Country:US
Practice Address - Phone:623-980-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor