Provider Demographics
NPI:1356719637
Name:KENNEDY, LISA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-3277
Mailing Address - Country:US
Mailing Address - Phone:951-515-3477
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1870
Practice Address - Country:US
Practice Address - Phone:951-515-3477
Practice Address - Fax:720-668-8954
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist