Provider Demographics
NPI:1619019296
Name:KENNEY, PHILIP SIMMONS (MS LPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:SIMMONS
Last Name:KENNEY
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 SW ST CLAIR ATT PHILIP KENNEY
Mailing Address - Street 2:SUITE #204
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205
Mailing Address - Country:US
Mailing Address - Phone:503-224-0781
Mailing Address - Fax:
Practice Address - Street 1:834 SW ST CLAIR ATT PHILIP KENNEY
Practice Address - Street 2:SUITE #204
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-224-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC 0074101Y00000X
ORT0039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist