Provider Demographics
NPI:1639580459
Name:BOTT, KENDRA (MFTSTUDENT INTERN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BOTT
Suffix:
Gender:F
Credentials:MFTSTUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 TAYLOR ROCK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2084
Mailing Address - Country:US
Mailing Address - Phone:702-281-3833
Mailing Address - Fax:
Practice Address - Street 1:3812 TAYLOR ROCK CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2084
Practice Address - Country:US
Practice Address - Phone:702-907-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist