Doctor Name: | MRS. BRIDGET ROSE KENNEDY |
NPI Number: | 1578941357 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 99348 |
Business Practice Address: | 3320 S Loop 256 Palestine, TX - 758016984 |
Business Phone Number: | 9037236136 |
Business Fax Number: | 9035893443 |
Mailing Address: | Po Box 3668, PALESTINE |
State: | TX |
Postal Code: | 758023668 |
Phone Number: | 9035120486 |
Fax Number: | 9035893443 |
NPI Enumeration Date: | 05/12/2015 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 99348 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |