Provider Demographics
NPI:1073621678
Name:KEGLEY, GENNA L (MS, LPC)
Entity Type:Individual
Prefix:
First Name:GENNA
Middle Name:L
Last Name:KEGLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 REDWATER RD APT 289
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5747
Mailing Address - Country:US
Mailing Address - Phone:817-542-2240
Mailing Address - Fax:
Practice Address - Street 1:6017 REEF POINT LN STE 135
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7006
Practice Address - Country:US
Practice Address - Phone:817-542-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20133101YP2500X
ARP1107047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20133OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
ARP1107047OtherSTATE OF ARKANSAS BOARD OF EXAMINERS IN COUNSELING