Provider Demographics
NPI:1417051798
Name:KENYON, MARK GLENN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GLENN
Last Name:KENYON
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 1:725 NORTH STREET
Mailing Address - Street 2:DEPT OF PSYCHIATRY
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8501
Mailing Address - Country:US
Mailing Address - Phone:413-447-2655
Mailing Address - Fax:413-447-2656
Practice Address - Street 1:725 NORTH STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8501
Practice Address - Country:US
Practice Address - Phone:413-447-2655
Practice Address - Fax:413-447-2656
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist