Provider Demographics
NPI:1982318200
Name:KENNEDY, CATHLEEN ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ELIZABETH
Last Name:KENNEDY
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 1:1760 E VILLA DR STE A
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4679
Mailing Address - Country:US
Mailing Address - Phone:928-646-0347
Mailing Address - Fax:928-646-7153
Practice Address - Street 1:1760 E VILLA DR STE A
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4679
Practice Address - Country:US
Practice Address - Phone:928-646-0347
Practice Address - Fax:928-646-7153
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21506103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-20506OtherLPC LICENSE.