Provider Demographics
NPI:1225467152
Name:KENNEY, CRYSTAL (LSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-1579
Mailing Address - Country:US
Mailing Address - Phone:502-538-1200
Mailing Address - Fax:502-538-1201
Practice Address - Street 1:330 HOPE ST
Practice Address - Street 2:
Practice Address - City:MT. WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047
Practice Address - Country:US
Practice Address - Phone:502-538-1200
Practice Address - Fax:502-538-1201
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3733104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker