Provider Demographics
NPI:1861624033
Name:KENNEL, PAMELA K (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:K
Last Name:KENNEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 242
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1522
Mailing Address - Country:US
Mailing Address - Phone:303-730-1144
Mailing Address - Fax:303-300-9222
Practice Address - Street 1:2305 E ARAPAHOE RD
Practice Address - Street 2:SUITE 242
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1522
Practice Address - Country:US
Practice Address - Phone:303-730-1144
Practice Address - Fax:303-300-9222
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9554101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1508100488OtherNATIONAL PROVIDER ID