Provider Demographics
NPI:1225223787
Name:PRESLEY, KENNETH BERNARD SR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BERNARD
Last Name:PRESLEY
Suffix:SR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 SILVER MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7153
Mailing Address - Country:US
Mailing Address - Phone:972-642-8488
Mailing Address - Fax:
Practice Address - Street 1:2101 W JOHN CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3228
Practice Address - Country:US
Practice Address - Phone:866-900-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist