Provider Demographics
NPI:1043071004
Name:KENNY, MARK T (MS LCPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:KENNY
Suffix:
Gender:M
Credentials:MS LCPC
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Mailing Address - Street 1:201 EAST ARMY TRAIL RD
Mailing Address - Street 2:SUITE#300D
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2106
Mailing Address - Country:US
Mailing Address - Phone:630-530-2220
Mailing Address - Fax:866-728-5493
Practice Address - Street 1:201 EAST ARMY TRAIL RD
Practice Address - Street 2:SUITE#300D
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2106
Practice Address - Country:US
Practice Address - Phone:630-530-2220
Practice Address - Fax:866-728-5493
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL180.000746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional