Provider Demographics
NPI:1750433660
Name:FINCH, KENNETH ALLEN (PHD, LMHC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALLEN
Last Name:FINCH
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2524
Mailing Address - Country:US
Mailing Address - Phone:850-747-8144
Mailing Address - Fax:850-747-0197
Practice Address - Street 1:752 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2524
Practice Address - Country:US
Practice Address - Phone:850-747-8144
Practice Address - Fax:850-747-0197
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-4520693OtherTAX IDENTIFICATION EFFECTIVE 7/1/15
FL52-2369274OtherTAX ID NUMBER