Provider Demographics
NPI:1184766743
Name:KENNINGTON, BRADLEY S (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:KENNINGTON
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 BEE CAVES RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5203
Mailing Address - Country:US
Mailing Address - Phone:512-732-2400
Mailing Address - Fax:512-732-2404
Practice Address - Street 1:4613 BEE CAVES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5203
Practice Address - Country:US
Practice Address - Phone:512-732-2400
Practice Address - Fax:512-732-2404
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18763101YM0800X
TX200752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health