Provider Demographics
NPI:1770256901
Name:KENNEDY, ASHLEY MEAD (LMSW-AP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MEAD
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMSW-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S CUSTER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-1452
Mailing Address - Country:US
Mailing Address - Phone:469-712-9134
Mailing Address - Fax:
Practice Address - Street 1:1402 S CUSTER RD STE 204
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-1452
Practice Address - Country:US
Practice Address - Phone:469-712-9134
Practice Address - Fax:469-631-0888
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical