Provider Demographics
NPI:1417080599
Name:KENTNOR, CHARLES MCGUFFIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MCGUFFIN
Last Name:KENTNOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3801
Mailing Address - Country:US
Mailing Address - Phone:720-226-6080
Mailing Address - Fax:720-336-8581
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:720-226-6080
Practice Address - Fax:720-336-8581
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3597103TC0700X, 103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling