Provider Demographics
NPI:1235884644
Name:DUNHAM, KENNETH LEE III (LPCC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:DUNHAM
Suffix:III
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 BEACHCOMBER DR E
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4783
Mailing Address - Country:US
Mailing Address - Phone:209-201-2245
Mailing Address - Fax:
Practice Address - Street 1:1899 E ROSEVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7980
Practice Address - Country:US
Practice Address - Phone:209-783-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17944101YP2500X
CAAPCC9903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist