Provider Demographics
NPI:1740766088
Name:KEMP, KENNETH EDWARD (LMHCA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:EDWARD
Last Name:KEMP
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:E
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9512 SW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8862
Mailing Address - Country:US
Mailing Address - Phone:435-729-9707
Mailing Address - Fax:
Practice Address - Street 1:9512 SW 153RD AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8862
Practice Address - Country:US
Practice Address - Phone:435-729-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61011110101YM0800X, 101YM0800X
ORR7591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist