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General NPI Number Information
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NPI Number | 1902554694
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Entity Type | Individual
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Provider Name | LORI L KENNISON LMHC, MAC, MCAP, CRC
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Gender | Female
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Dates
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Enumeration Date | 03/12/2022
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Last Update Date | 03/12/2022
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Provider Practice Location Address
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Address Line | 2750 N MCMULLEN BOOTH RD STE 102A
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City | CLEARWATER
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State | FL
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Zip | 33761-3362
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Country | US
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Telephone | 727-560-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 768 89TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-3014
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Country | US
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Telephone | 727-560-7632
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH15343
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License Number State | FL
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