Provider Demographics
NPI:1720684962
Name:DAILEY, KENDRA ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ELAINE
Last Name:DAILEY
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 1:435 S ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4903
Mailing Address - Country:US
Mailing Address - Phone:972-372-4236
Mailing Address - Fax:
Practice Address - Street 1:2150 LAKESIDE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4467
Practice Address - Country:US
Practice Address - Phone:972-437-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional