Healthcare Provider Details

I. General information

NPI: 1194599506
Provider Name (Legal Business Name): KENETRIA NEWMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 ALMA DR
PLANO TX
75025-3568
US

IV. Provider business mailing address

PO BOX 167273
IRVING TX
75016-7273
US

V. Phone/Fax

Practice location:
  • Phone: 972-422-5939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: