Provider Demographics
NPI:1972764181
Name:MINTON, KEKUNI
Entity Type:Individual
Prefix:MR
First Name:KEKUNI
Middle Name:
Last Name:MINTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 COUNTY ROAD 49
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9745
Mailing Address - Country:US
Mailing Address - Phone:719-219-1010
Mailing Address - Fax:
Practice Address - Street 1:134 F ST STE 210
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2160
Practice Address - Country:US
Practice Address - Phone:719-239-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health