MEDICARE: MARY M. KENAN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	30875	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881774149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M. KENAN PSY.D.

Provider Business Mailing Address
First Line	:	7200 CAMBRIDGE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4202
Country	:	US
Telephone Number	:	713-798-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 E T C JESTER BLVD STE 238
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1449
Country	:	US
Telephone Number	:	713-826-1587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/11/2021

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