Provider Demographics
NPI:1932956984
Name:KENYON COUNSELING LCSW PLLC
Entity Type:Organization
Organization Name:KENYON COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-378-9791
Mailing Address - Street 1:PO BOX 1222
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-0222
Mailing Address - Country:US
Mailing Address - Phone:607-378-9791
Mailing Address - Fax:
Practice Address - Street 1:7148 ROUTE 21 APT 2
Practice Address - Street 2:
Practice Address - City:ALMOND
Practice Address - State:NY
Practice Address - Zip Code:14804-9670
Practice Address - Country:US
Practice Address - Phone:607-378-9791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty