Provider Demographics
NPI:1982232096
Name:BLEDSOE, KENYA GRACE (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:KENYA
Middle Name:GRACE
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3093
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3100
Mailing Address - Country:US
Mailing Address - Phone:205-317-9699
Mailing Address - Fax:
Practice Address - Street 1:669 CENTERPOINTE CV
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7720
Practice Address - Country:US
Practice Address - Phone:205-317-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health