Provider Demographics
NPI:1114439106
Name:KENNECT PSYCHOTHERAPY PC
Entity Type:Organization
Organization Name:KENNECT PSYCHOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:214-662-1040
Mailing Address - Street 1:155 MONTGOMERY ST STE 507
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4110
Mailing Address - Country:US
Mailing Address - Phone:415-494-7686
Mailing Address - Fax:
Practice Address - Street 1:155 MONTGOMERY ST STE 507
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4110
Practice Address - Country:US
Practice Address - Phone:415-494-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health