Provider Demographics
NPI:1740821255
Name:KENNETT, MACKENZIE ERIN
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ERIN
Last Name:KENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 CENTRAL PIKE
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-7718
Mailing Address - Country:US
Mailing Address - Phone:859-325-3678
Mailing Address - Fax:
Practice Address - Street 1:636 CENTRAL PIKE
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-7718
Practice Address - Country:US
Practice Address - Phone:859-325-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool