Provider Demographics
NPI:1578716171
Name:DENNIS, KENNETH (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:DENNIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 WOODMOOR DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7464
Mailing Address - Country:US
Mailing Address - Phone:719-321-1976
Mailing Address - Fax:866-384-1465
Practice Address - Street 1:1864 WOODMOOR DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9095
Practice Address - Country:US
Practice Address - Phone:719-321-1876
Practice Address - Fax:866-384-1465
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional