Provider Demographics
NPI:1225535123
Name:BROOKS MS LPCC, KENNA MICHELLE
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:MICHELLE
Last Name:BROOKS MS LPCC
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 1:75 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-3026
Mailing Address - Country:US
Mailing Address - Phone:937-576-4494
Mailing Address - Fax:
Practice Address - Street 1:75 SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-3026
Practice Address - Country:US
Practice Address - Phone:937-576-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional