Provider Demographics
NPI:1669492302
Name:KENNEDY, TERESA ROSELLE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ROSELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CLOVERLEAF PL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-2486
Mailing Address - Country:US
Mailing Address - Phone:406-861-5578
Mailing Address - Fax:
Practice Address - Street 1:1340 CLOVERLEAF PL
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-2486
Practice Address - Country:US
Practice Address - Phone:406-861-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional