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NPI Code Detail

MEDICARE: KINNEDY RAYNE VANDEVENDER LPC

MEDICARE: KINNEDY RAYNE VANDEVENDER LPC
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
1101YM0800XMental Health Counselor91109TX
2101YP2500XProfessional Counselor91109TX

General Provider Information

NPI Number : 1982558938
Entity Type Code : Individual
Provider Name (Legal Business Name) : KINNEDY RAYNE VANDEVENDER LPC
Provider Business Mailing Address
First Line : 64 HERITAGE DR
Second Line :
City : VIDOR
State : TX
Zip : 77662-6050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2750 S 8TH ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77701-7719
Country : US
Telephone Number : 409-839-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2026
Last Update Date : 03/05/2026

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Directions to “ KINNEDY RAYNE VANDEVENDER LPC” Practice Location

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