Provider Demographics
NPI:1750368106
Name:REED, KENNETH EUGENE (LPCC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:REED
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BROADWAY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6065
Mailing Address - Country:US
Mailing Address - Phone:505-393-0692
Mailing Address - Fax:505-393-0796
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6065
Practice Address - Country:US
Practice Address - Phone:505-393-0692
Practice Address - Fax:505-393-0796
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19173512Medicaid