Provider Demographics
NPI:1417071739
Name:KENNEDY, BARBARA ELLEN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELLEN
Last Name:KENNEDY
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 1:4105 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1913
Mailing Address - Country:US
Mailing Address - Phone:219-464-3762
Mailing Address - Fax:
Practice Address - Street 1:4105 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-1913
Practice Address - Country:US
Practice Address - Phone:219-464-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000610A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor