Provider Demographics
NPI:1336645654
Name:KENNAN, KEVIN (MFTC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:KENNAN
Suffix:
Gender:M
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E 112TH PL
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3100
Mailing Address - Country:US
Mailing Address - Phone:720-939-3514
Mailing Address - Fax:
Practice Address - Street 1:9351 GRANT ST STE 480
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4375
Practice Address - Country:US
Practice Address - Phone:720-939-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty