Kenline, Tracy
Kenline, Tracy is an sole proprietor health care provider with primary practice located at 740 Burbank St , Broomfield CO 80020-1658. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Kenline, Tracy can be contacted via phone (720) 495-7741.Contact Information
Primary practice address
740 Burbank St
Broomfield CO 80020-1658
Phone: (720) 495-7741
Fax: (855) 458-4470
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | SW7622 | Florida |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 1453 | Colorado |
Profile Details
| NPI number | 1629199765 |
|---|---|
| LBN Legal business name | Kenline, Tracy |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 3rd, 2007 |
| Last updated | Nov 21st, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629199765 | NPPES |
| Colorado | Other | 12076183 | CAQH |
| Colorado | Other | 45-2792123 | CAQH |
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