Individual provider Active NPI

Charles McGuffin Kentnor, PSY.D.

  • Clinical Psychologist
  • Denver, CO
National Provider Identifier
1417080599
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3597 Issued in CO
Practice address
1776 S Jackson St
Suite 205
Denver, CO 80210-3801
Phone
(720) 226-6080
Fax
(720) 336-8581
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3597 CO Primary
Psychologist 103T00000X 3597 CO
Counseling Psychologist 103TC1900X 3597 CO

Addresses

Primary practice location

1776 S Jackson St
Suite 205
Denver, CO 80210-3801

Mailing address

1776 S Jackson St
Suite 205
Denver, CO 80210-3801
Phone (720) 226-6080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3597COMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433289600000",
    "number": "1417080599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 S JACKSON ST",
            "address_2": "SUITE 205",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802103801",
            "telephone_number": "720-226-6080",
            "fax_number": "720-336-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 S JACKSON ST",
            "address_2": "SUITE 205",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802103801",
            "telephone_number": "720-226-6080",
            "fax_number": "720-336-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENTNOR",
        "first_name": "CHARLES",
        "middle_name": "MCGUFFIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2015-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "3597",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "3597",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CO",
            "license": "3597",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.