Provider Demographics
NPI:1194361345
Name:KERTON, BRENDON MICHAEL (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:MICHAEL
Last Name:KERTON
Suffix:
Gender:M
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 WHEEL CIR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1573
Mailing Address - Country:US
Mailing Address - Phone:603-498-1166
Mailing Address - Fax:
Practice Address - Street 1:811 MAIN CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1851
Practice Address - Country:US
Practice Address - Phone:970-704-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.0013230OtherCOLORADO LICENSE