Provider Demographics
NPI:1770631798
Name:HAWK, KENDALL HAVEN (LPC-MHSP, CEAP)
Entity Type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:HAVEN
Last Name:HAWK
Suffix:
Gender:F
Credentials:LPC-MHSP, CEAP
Other - Prefix:MRS
Other - First Name:KENDALL
Other - Middle Name:DENAE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP, CEAP
Mailing Address - Street 1:PO BOX 1571
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172
Mailing Address - Country:US
Mailing Address - Phone:615-714-2088
Mailing Address - Fax:615-449-4709
Practice Address - Street 1:706 CADET COURT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-714-2088
Practice Address - Fax:615-449-4709
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1519101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441132Medicaid