Provider Demographics
NPI:1609952506
Name:KINSEY, VINCENT SHUMPERT (LPC-11606)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:SHUMPERT
Last Name:KINSEY
Suffix:
Gender:M
Credentials:LPC-11606
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 W CHARTER OAK RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3307
Mailing Address - Country:US
Mailing Address - Phone:623-205-0208
Mailing Address - Fax:623-433-8985
Practice Address - Street 1:7141 N 51ST AVE STE D3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2673
Practice Address - Country:US
Practice Address - Phone:623-433-8875
Practice Address - Fax:623-433-8985
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health