Provider Demographics
NPI:1346775822
Name:KENNEDY, CARTELIA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CARTELIA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MRS
Other - First Name:CARTELIA
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:802 WILSON RANCH PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3173
Mailing Address - Country:US
Mailing Address - Phone:512-773-5037
Mailing Address - Fax:
Practice Address - Street 1:802 WILSON RANCH PL
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3173
Practice Address - Country:US
Practice Address - Phone:512-773-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health