Provider Demographics
NPI:1588206759
Name:ENGLUND, KENNETH ROBERT OWEN (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT OWEN
Last Name:ENGLUND
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 1:22 INDIANWOODS RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9237
Mailing Address - Country:US
Mailing Address - Phone:470-485-2335
Mailing Address - Fax:
Practice Address - Street 1:22 INDIANWOODS RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9237
Practice Address - Country:US
Practice Address - Phone:470-485-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional