Provider Demographics
NPI:1497068456
Name:LIDDELL, KENYA R (LPC, BC-TMH)
Entity Type:Individual
Prefix:MRS
First Name:KENYA
Middle Name:R
Last Name:LIDDELL
Suffix:
Gender:F
Credentials:LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-0940
Mailing Address - Country:US
Mailing Address - Phone:870-466-4773
Mailing Address - Fax:
Practice Address - Street 1:162 E. MILITARY ROAD, SUITE B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-7236
Practice Address - Country:US
Practice Address - Phone:870-466-4773
Practice Address - Fax:870-466-4773
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional