Provider Demographics
NPI:1497064984
Name:KENNETH D. ALLRED, PH.D., P.C.
Entity Type:Organization
Organization Name:KENNETH D. ALLRED, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-590-6005
Mailing Address - Street 1:121 SOUTH TEJON ST.
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2214
Mailing Address - Country:US
Mailing Address - Phone:719-590-6005
Mailing Address - Fax:719-590-6030
Practice Address - Street 1:121 SOUTH TEJON ST.
Practice Address - Street 2:SUITE 1107
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2214
Practice Address - Country:US
Practice Address - Phone:719-590-6005
Practice Address - Fax:719-590-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty