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General NPI Number Information
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NPI Number | 1679117055
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Entity Type | Organization
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Legal Business Name | KENNETH MCKENNA, PHD LLC
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 1402 N CORINTH ST STE 112
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City | CORINTH
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State | TX
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Zip | 76208-5445
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Country | US
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Telephone | 940-595-9152
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Fax | 940-279-1386
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Provider Business Mailing Address
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Address Line | 1402 N CORINTH ST STE 112
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City | CORINTH
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State | TX
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Zip | 76208-5445
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Country | US
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Telephone | 940-595-9152
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KENNETH ALLEN MCKENNA
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Credential | PH.D.
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Telephone | 940-595-9152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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