Provider Demographics
NPI:1730815382
Name:KINYON, SELENE DENISE (CADC-R)
Entity type:Individual
Prefix:
First Name:SELENE
Middle Name:DENISE
Last Name:KINYON
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 NW CITY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5418
Mailing Address - Country:US
Mailing Address - Phone:541-390-0559
Mailing Address - Fax:
Practice Address - Street 1:1463 NW CITY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5418
Practice Address - Country:US
Practice Address - Phone:541-390-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)