Provider Demographics
NPI:1831887421
Name:KENISON, JONINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JONINA
Middle Name:
Last Name:KENISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JONINA
Other - Middle Name:LYN
Other - Last Name:MORIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-1041
Mailing Address - Country:US
Mailing Address - Phone:850-368-4070
Mailing Address - Fax:
Practice Address - Street 1:308 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-7610
Practice Address - Country:US
Practice Address - Phone:850-368-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-552771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty