Provider Demographics
NPI:1053682658
Name:KENNING, TAMARA LYN (LIMHP, LPC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYN
Last Name:KENNING
Suffix:
Gender:F
Credentials:LIMHP, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2108
Mailing Address - Country:US
Mailing Address - Phone:402-643-4954
Mailing Address - Fax:
Practice Address - Street 1:122 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2108
Practice Address - Country:US
Practice Address - Phone:402-643-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1054101YA0400X
NE1171101YM0800X
NE2063101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE600980624Medicaid