Provider Demographics
NPI:1811103062
Name:KENNEDY, MICHELLE KATHLEEN (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHLEEN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KATHLEEN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2251 GRANT ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6958
Mailing Address - Country:US
Mailing Address - Phone:650-260-7500
Mailing Address - Fax:650-397-4425
Practice Address - Street 1:2251 GRANT ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6958
Practice Address - Country:US
Practice Address - Phone:650-260-7500
Practice Address - Fax:650-397-4425
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist