Provider Demographics
NPI:1831115856
Name:SEARCY, KENNETH W (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:SEARCY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 BONITA RD.
Mailing Address - Street 2:#493
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:760-789-6389
Mailing Address - Fax:760-789-6389
Practice Address - Street 1:4364 BONITA RD.
Practice Address - Street 2:#493
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1421
Practice Address - Country:US
Practice Address - Phone:760-789-6389
Practice Address - Fax:760-789-6389
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY11271Medicaid
CAR15130Medicare UPIN