Basic Information
| Provider Information | |||||||||
| NPI: | 1518091669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSNOT | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4455 E 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802202415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035047700 | ||||||||
| FaxNumber: | 3035128858 | ||||||||
| Practice Location | |||||||||
| Address1: | 4455 E 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802202415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035047700 | ||||||||
| FaxNumber: | 3035128858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180-004314 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | LPC.0015516 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.