Healthcare Provider Details

I. General information

NPI: 1700795986
Provider Name (Legal Business Name): KENNEDY JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 ALICE ST
DENTON TX
76201-2873
US

IV. Provider business mailing address

169 MADISON AVE STE 15011
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 214-901-4167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93040
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: