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General NPI Number Information
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NPI Number | 1891411559
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Entity Type | Organization
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Legal Business Name | TRACY KENNEDY COUNSELING LLC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 1142 HIGHWAY 71 S STE C
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City | MENA
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State | AR
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Zip | 71953-8078
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Country | US
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Telephone | 479-437-7967
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Fax |
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Provider Business Mailing Address
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Address Line | 151 ALLEN LN
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City | ODEN
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State | AR
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Zip | 71961-8069
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Country | US
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Telephone | 479-216-4262
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACY KENNEDY
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Credential |
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Telephone | 479-216-4262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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