Provider Demographics
NPI:1144346156
Name:LOUD, KENNETH WAYNE (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WAYNE
Last Name:LOUD
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:MR
Other - First Name:K.
Other - Middle Name:WAYNE
Other - Last Name:LOUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:390 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9470
Mailing Address - Country:US
Mailing Address - Phone:541-997-7134
Mailing Address - Fax:541-902-7528
Practice Address - Street 1:390 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9470
Practice Address - Country:US
Practice Address - Phone:541-997-7134
Practice Address - Fax:541-902-7528
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2024101YM0800X
ORT0553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273263Medicaid