NPI 1124613716 · live from the CMS NPI Registry
Kenneth Gillespie, Ph.D, MS
Marriage & Family Therapist in Fairbanks, AK. National Provider Identifier 1124613716, active.
NPI record
| NPI | 1124613716 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Marriage & Family Therapist 106H00000X |
| Practice location | 209 Forty Mile Ave, Fairbanks, AK 99701 |
| Practice phone | 907-456-6445 |
| Enumerated | March 4, 2021 |
| Last updated | March 4, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health | 101YM0800X | — |
| Marriage & Family Therapist primary | 106H00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.