Provider Demographics
NPI:1346561982
Name:KENNEDY, KAREN MILLS (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MILLS
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 MANCHACA ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-653-0554
Mailing Address - Fax:512-443-4844
Practice Address - Street 1:3625 MANCHACA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6631
Practice Address - Country:US
Practice Address - Phone:512-653-0554
Practice Address - Fax:512-443-4844
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional