Individual
GARY KENYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12918 W PALM LN, AVONDALE, AZ 85392-7153
(469) 781-8182
Mailing address
PO BOX 1891, SNOWFLAKE, AZ 85937-1891
(469) 781-8182
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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