Provider Demographics
NPI:1881061133
Name:KENNEDY, CRYSTAL (LPC-S)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 VERSAILLES BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2351
Mailing Address - Country:US
Mailing Address - Phone:337-456-7880
Mailing Address - Fax:337-456-7882
Practice Address - Street 1:222 RUE DE JEAN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3388
Practice Address - Country:US
Practice Address - Phone:337-456-7880
Practice Address - Fax:337-456-7882
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional