Provider Demographics
NPI:1710576921
Name:GALLEGOS REICHLE, KENDRA LYNNE (LPC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNNE
Last Name:GALLEGOS REICHLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W 22ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4618
Mailing Address - Country:US
Mailing Address - Phone:970-749-7790
Mailing Address - Fax:
Practice Address - Street 1:202 W 22ND ST STE 2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4618
Practice Address - Country:US
Practice Address - Phone:970-749-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health