Provider Demographics
NPI:1740472190
Name:KINNEY, JOHN (LADAC, LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KINNEY
Suffix:
Gender:
Credentials:LADAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 SEQUOIA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1249
Mailing Address - Country:US
Mailing Address - Phone:505-836-7330
Mailing Address - Fax:505-836-7424
Practice Address - Street 1:5310 SEQUOIA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1249
Practice Address - Country:US
Practice Address - Phone:505-836-7330
Practice Address - Fax:505-836-7424
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4904, 4905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)