Provider Demographics
NPI:1255486254
Name:KARRELS, KENNETH VERNON (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:VERNON
Last Name:KARRELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 NO SMOKEY TOPAZ
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9711
Mailing Address - Country:US
Mailing Address - Phone:520-749-5345
Mailing Address - Fax:520-760-5594
Practice Address - Street 1:6612 E CARONDELET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-886-6588
Practice Address - Fax:520-885-6500
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ723103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
67385Medicare ID - Type Unspecified