Provider Demographics
NPI:1831452374
Name:KENNEDY, JAMES RYAN (LP, LAC, LMFT, RN)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RYAN
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LP, LAC, LMFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7040
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-0040
Mailing Address - Country:US
Mailing Address - Phone:303-399-9988
Mailing Address - Fax:303-399-9977
Practice Address - Street 1:5833 E 33RD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2112
Practice Address - Country:US
Practice Address - Phone:303-399-9988
Practice Address - Fax:303-399-9977
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5731103TC0700X
CO492101YA0400X
CO1570101YP2500X
CO804106H00000X
CO116891163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health