Provider Demographics
NPI:1497496723
Name:ANDERSON, KENDRA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25452 W MAHONEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1448
Mailing Address - Country:US
Mailing Address - Phone:480-251-2340
Mailing Address - Fax:
Practice Address - Street 1:25452 W MAHONEY AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1448
Practice Address - Country:US
Practice Address - Phone:480-251-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC20685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional