Healthcare Provider Details

I. General information

NPI: 1134149214
Provider Name (Legal Business Name): JAMES ANDREW KENNY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W HARRISON ST SUITE 4
RENSSELAER IN
47978-2839
US

IV. Provider business mailing address

219 W HARRISON ST SUITE 4
RENSSELAER IN
47978-2839
US

V. Phone/Fax

Practice location:
  • Phone: 219-866-7869
  • Fax: 219-866-0688
Mailing address:
  • Phone: 219-866-7869
  • Fax: 219-866-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20010007
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: