Provider Demographics
NPI:1457445140
Name:KENT, JOHN TAYLOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TAYLOR
Last Name:KENT
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:PO BOX 201163
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-1163
Mailing Address - Country:US
Mailing Address - Phone:480-861-9221
Mailing Address - Fax:
Practice Address - Street 1:1201 E. BUTTE AVE
Practice Address - Street 2:ARIZONA STATE PRISON COMPLEX
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232
Practice Address - Country:US
Practice Address - Phone:520-868-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3339103TC0700X
ID497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical