Provider Demographics
NPI:1578941357
Name:KENNEDY, BRIDGET ROSE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ROSE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ROSE
Other - Last Name:HOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3668
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-3668
Mailing Address - Country:US
Mailing Address - Phone:903-512-0486
Mailing Address - Fax:903-589-3443
Practice Address - Street 1:3320 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6984
Practice Address - Country:US
Practice Address - Phone:903-723-6136
Practice Address - Fax:903-589-3443
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99348101Y00000X
TX70364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor