Provider Demographics
NPI:1639271448
Name:MAINS, KEVIN A (LPCC CEDP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:MAINS
Suffix:
Gender:M
Credentials:LPCC CEDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 JUAN TABO NE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-275-6669
Mailing Address - Fax:505-298-3939
Practice Address - Street 1:3900 JUAN TABO NE
Practice Address - Street 2:SUITE 16
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-275-6669
Practice Address - Fax:505-298-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional