Provider Demographics
NPI:1306964515
Name:DUNCAN, KENNETH ALLEN (MS, MFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALLEN
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 BLUE GUM AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-1052
Mailing Address - Country:US
Mailing Address - Phone:209-525-5401
Mailing Address - Fax:209-525-5498
Practice Address - Street 1:2215 BLUE GUM AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-1052
Practice Address - Country:US
Practice Address - Phone:209-525-5401
Practice Address - Fax:209-525-5498
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist