Provider Demographics
NPI:1396368783
Name:KENNEDY, SIYUAN CHEN (DPC LPC NCC BC-TMH)
Entity Type:Individual
Prefix:
First Name:SIYUAN
Middle Name:CHEN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DPC LPC NCC BC-TMH
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPC LPC NCC BC-TMH
Mailing Address - Street 1:108 SANDSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047
Mailing Address - Country:US
Mailing Address - Phone:601-842-4957
Mailing Address - Fax:
Practice Address - Street 1:108 SANDSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047
Practice Address - Country:US
Practice Address - Phone:601-842-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional