Provider Demographics
NPI:1144774860
Name:KENNEMER, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KENNEMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 NURSERY DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1178
Mailing Address - Country:US
Mailing Address - Phone:361-482-0427
Mailing Address - Fax:361-482-0426
Practice Address - Street 1:6502 NURSERY DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1178
Practice Address - Country:US
Practice Address - Phone:361-482-0427
Practice Address - Fax:361-482-0426
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73165251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX73165OtherTEXAS BOARD OF LICENSED PROFESSIONAL COUNSELORS