Provider Demographics
NPI:1619106549
Name:NOREM, KENNETH EUGENE (PHD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:NOREM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5338
Mailing Address - Country:US
Mailing Address - Phone:970-397-4858
Mailing Address - Fax:
Practice Address - Street 1:1508 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5338
Practice Address - Country:US
Practice Address - Phone:970-397-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2799101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist