Provider Demographics
NPI:1821757907
Name:TEVIS, KENDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:TEVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CLIFF HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-5331
Mailing Address - Country:US
Mailing Address - Phone:469-583-4592
Mailing Address - Fax:
Practice Address - Street 1:228 CLIFF HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-5331
Practice Address - Country:US
Practice Address - Phone:469-583-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical