Healthcare Provider Details

I. General information

NPI: 1275377251
Provider Name (Legal Business Name): AMY HARPER KENNEDY PLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 1ST AVE
LAKE CHARLES LA
70601-8897
US

IV. Provider business mailing address

2903 1ST AVE
LAKE CHARLES LA
70601-8897
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-6480
  • Fax: 337-474-9637
Mailing address:
  • Phone: 337-478-6480
  • Fax: 337-474-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10232
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: