Provider Demographics
NPI:1184994204
Name:KENNEY, MARK VICTOR (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:VICTOR
Last Name:KENNEY
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 1:456 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2454
Mailing Address - Country:US
Mailing Address - Phone:816-529-8968
Mailing Address - Fax:
Practice Address - Street 1:7501 COLLEGE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1944
Practice Address - Country:US
Practice Address - Phone:913-451-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3574597797103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool