Healthcare Provider Details

I. General information

NPI: 1184553794
Provider Name (Legal Business Name): MOLLY KENNEDY IRVIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WINDHOEK DR
LINCOLN NE
68512-1272
US

IV. Provider business mailing address

1600 WINDHOEK DR
LINCOLN NE
68512-1272
US

V. Phone/Fax

Practice location:
  • Phone: 531-248-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14876
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: