Provider Demographics
NPI:1083765317
Name:MCCARTY, KEN E (LMFT)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:E
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 SIMEONOF ST.
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615
Mailing Address - Country:US
Mailing Address - Phone:530-515-1089
Mailing Address - Fax:530-241-9221
Practice Address - Street 1:1423 SIMEONOF ST
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6452
Practice Address - Country:US
Practice Address - Phone:530-515-1089
Practice Address - Fax:530-241-9221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health