Provider Demographics
NPI:1134387236
Name:KENNEDY, JANET MALINDA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MALINDA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, LMFT
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 517
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93515-0517
Mailing Address - Country:US
Mailing Address - Phone:760-873-4959
Mailing Address - Fax:
Practice Address - Street 1:67 LUCAS RD
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-7069
Practice Address - Country:US
Practice Address - Phone:760-873-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist