Provider Demographics
NPI:1184956278
Name:JORDAN, KENYON P (PHD)
Entity type:Individual
Prefix:DR
First Name:KENYON
Middle Name:P
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 E ARAPAHOE RD
Mailing Address - Street 2:STE 240
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1266
Mailing Address - Country:US
Mailing Address - Phone:303-986-0026
Mailing Address - Fax:303-986-0026
Practice Address - Street 1:7700 E ARAPAHOE RD
Practice Address - Street 2:STE 240
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1266
Practice Address - Country:US
Practice Address - Phone:303-986-0026
Practice Address - Fax:303-986-0026
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2187103TC1900X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling