Provider Demographics
NPI:1740795327
Name:HANEY, KENYON PAUL (LPC)
Entity Type:Individual
Prefix:
First Name:KENYON
Middle Name:PAUL
Last Name:HANEY
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 1:5207 S AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3222
Mailing Address - Country:US
Mailing Address - Phone:806-236-1832
Mailing Address - Fax:
Practice Address - Street 1:4037 SW 50TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6181
Practice Address - Country:US
Practice Address - Phone:806-236-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74222101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor