Provider Demographics
NPI:1255177861
Name:KANNENBERG, MAI (LPC)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:KANNENBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 N BUCKNER ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2948
Mailing Address - Country:US
Mailing Address - Phone:316-788-6464
Mailing Address - Fax:
Practice Address - Street 1:1525 N BUCKNER ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2948
Practice Address - Country:US
Practice Address - Phone:316-788-6464
Practice Address - Fax:206-299-1262
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty