Provider Demographics
NPI:1790837573
Name:JANZEN, KENNETH DUANE (MFT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DUANE
Last Name:JANZEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BARSTOW
Mailing Address - Street 2:#109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-228-8778
Mailing Address - Fax:559-228-8329
Practice Address - Street 1:125 E BARSTOW
Practice Address - Street 2:#109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-228-8778
Practice Address - Fax:559-228-8329
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27869103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist