Provider Demographics
NPI:1750754396
Name:GOODRICH, KENNY (MS, LMHC)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1514
Mailing Address - Country:US
Mailing Address - Phone:786-317-2526
Mailing Address - Fax:
Practice Address - Street 1:4331 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1514
Practice Address - Country:US
Practice Address - Phone:786-317-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health