Provider Demographics
NPI:1467165746
Name:VALLADOLID, KENZIE
Entity Type:Individual
Prefix:MRS
First Name:KENZIE
Middle Name:
Last Name:VALLADOLID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W TOMICHI AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2745
Mailing Address - Country:US
Mailing Address - Phone:719-851-0429
Mailing Address - Fax:
Practice Address - Street 1:304 W TOMICHI AVE STE 12
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2745
Practice Address - Country:US
Practice Address - Phone:719-851-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health