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General NPI Number Information
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NPI Number | 1629576806
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Entity Type | Individual
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Provider Name | FAYE REBECCA KENNELLY LPC, ATR
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 2511 E 6TH ST STE B
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City | AUSTIN
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State | TX
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Zip | 78702-0047
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Country | US
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Telephone | 401-529-8194
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Fax | 401-529-8194
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Provider Business Mailing Address
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Address Line | 1209 GARDEN ST
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City | AUSTIN
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State | TX
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Zip | 78702-5322
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Country | US
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Telephone | 401-529-8194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 75684
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License Number State | TX
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