Provider Demographics
NPI:1376320226
Name:MCKENNA, CHARLES F (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:F
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 CLARK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9711
Mailing Address - Country:US
Mailing Address - Phone:719-221-5197
Mailing Address - Fax:
Practice Address - Street 1:1548 G ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2645
Practice Address - Country:US
Practice Address - Phone:719-221-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0001888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional