Provider Demographics
NPI:1750330395
Name:KENNEDY-REITER, KERRI LEIGH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LEIGH
Last Name:KENNEDY-REITER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 KIOWA DR W
Mailing Address - Street 2:
Mailing Address - City:LAKE KIOWA
Mailing Address - State:TX
Mailing Address - Zip Code:76240-9596
Mailing Address - Country:US
Mailing Address - Phone:940-668-1842
Mailing Address - Fax:
Practice Address - Street 1:115 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3911
Practice Address - Country:US
Practice Address - Phone:940-665-8056
Practice Address - Fax:940-665-8057
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional