Provider Demographics
NPI:1740242197
Name:KENNEY, GREGORY R (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:R
Last Name:KENNEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711-0218
Mailing Address - Country:US
Mailing Address - Phone:304-856-3841
Mailing Address - Fax:
Practice Address - Street 1:278 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1415
Practice Address - Country:US
Practice Address - Phone:304-822-4530
Practice Address - Fax:304-822-7225
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001790057OtherMOUNTAIN STATE BCBS