Provider Demographics
NPI:1679117055
Name:KENNETH MCKENNA, PHD LLC
Entity Type:Organization
Organization Name:KENNETH MCKENNA, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:940-595-9152
Mailing Address - Street 1:1402 N CORINTH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5445
Mailing Address - Country:US
Mailing Address - Phone:940-595-9152
Mailing Address - Fax:
Practice Address - Street 1:1402 N CORINTH ST STE 112
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5445
Practice Address - Country:US
Practice Address - Phone:940-595-9152
Practice Address - Fax:940-279-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346307915OtherNPPES