Provider Demographics
NPI:1407390925
Name:DEAN, KENNETH (LCPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N MILES AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-2356
Mailing Address - Country:US
Mailing Address - Phone:406-665-4103
Mailing Address - Fax:
Practice Address - Street 1:16 N MILES AVE STE 101
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-2356
Practice Address - Country:US
Practice Address - Phone:406-665-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101YA0400X
WYLPC-2225101YM0800X
MTBBH-LCPC-LIC-44183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)