Provider Demographics
NPI:1376857599
Name:KENNEDY, KELLY (MS, LMFT-I)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1501
Mailing Address - Country:US
Mailing Address - Phone:864-583-1010
Mailing Address - Fax:864-582-6361
Practice Address - Street 1:167 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1501
Practice Address - Country:US
Practice Address - Phone:864-583-1010
Practice Address - Fax:864-582-6361
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist