Provider Demographics
NPI:1568003135
Name:KENNEDY, AMBER MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC INTERN
Mailing Address - Street 1:1412 N AVENUE K
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-3316
Mailing Address - Country:US
Mailing Address - Phone:940-256-0467
Mailing Address - Fax:
Practice Address - Street 1:598 WESTWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-6828
Practice Address - Country:US
Practice Address - Phone:325-244-5407
Practice Address - Fax:325-244-5597
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78573101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health