Individual
KENNETH BRYAN MCINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
851 E WESTPOINT DR STE 302, WASILLA, AK 99654
(907) 917-5900
(907) 917-5902
Mailing address
PO BOX 871431, WASILLA, AK 99687-1431
(907) 917-5900
(907) 917-5902
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PCOP808
AK
Other
Enumeration date
09/06/2013
Last updated
12/02/2019
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