Provider Demographics
NPI:1679247746
Name:KENNEDY, PATRICK ALAN (LMHCA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALAN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 LINCOLNWAY W STE T
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-2063
Mailing Address - Country:US
Mailing Address - Phone:574-651-8912
Mailing Address - Fax:574-281-4412
Practice Address - Street 1:1415 LINCOLNWAY W STE T
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2063
Practice Address - Country:US
Practice Address - Phone:574-651-8912
Practice Address - Fax:574-281-4412
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health