Provider Demographics
NPI:1700219870
Name:MAXWELL, KENDRA JANAI (MA, LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:JANAI
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-8404
Mailing Address - Country:US
Mailing Address - Phone:918-839-4141
Mailing Address - Fax:
Practice Address - Street 1:3111 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5412
Practice Address - Country:US
Practice Address - Phone:918-839-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor