Provider Demographics
NPI:1245963057
Name:KENNY, HALEY ELIZABETH
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ELIZABETH
Last Name:KENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:ELIZABETH
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 CHICKAT TRL
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2837
Mailing Address - Country:US
Mailing Address - Phone:850-691-6688
Mailing Address - Fax:
Practice Address - Street 1:10611 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3441
Practice Address - Country:US
Practice Address - Phone:850-643-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health