Provider Demographics
NPI:1063900553
Name:KENYON, COLEEN ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:ELIZABETH
Last Name:KENYON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 ASTER ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1060
Mailing Address - Country:US
Mailing Address - Phone:484-903-9409
Mailing Address - Fax:
Practice Address - Street 1:90 S COMMERCE WAY STE 300
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8611
Practice Address - Country:US
Practice Address - Phone:610-691-8401
Practice Address - Fax:610-691-0647
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional