Provider Demographics
NPI:1275719171
Name:KENNARD, AMANDA MCDONALD (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MCDONALD
Last Name:KENNARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 BRUING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-2461
Mailing Address - Country:US
Mailing Address - Phone:941-916-5291
Mailing Address - Fax:
Practice Address - Street 1:207 CROSS ST
Practice Address - Street 2:STE 103
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4445
Practice Address - Country:US
Practice Address - Phone:941-916-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health