Provider Demographics
NPI:1851449367
Name:KENYON, JOHN GORDON JR (MS LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GORDON
Last Name:KENYON
Suffix:JR
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E COLLEGE AVE
Mailing Address - Street 2:#460
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5558
Mailing Address - Country:US
Mailing Address - Phone:814-231-0940
Mailing Address - Fax:814-231-4702
Practice Address - Street 1:444 E COLLEGE AVE
Practice Address - Street 2:#460
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5558
Practice Address - Country:US
Practice Address - Phone:814-231-0940
Practice Address - Fax:814-231-4702
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000714101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)