MEDICARE: MRS. AMBER MARIE KENNEDY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	78573	TX
2	101YM0800X	Mental Health Counselor	78573	TX
3	101YP2500X	Professional Counselor	78573	TX

General Provider Information

NPI Number	:	1568003135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER MARIE KENNEDY LPC

Provider Business Mailing Address
First Line	:	1412 N AVENUE K
Second Line	:
City	:	HASKELL
State	:	TX
Zip	:	79521-3316
Country	:	US
Telephone Number	:	940-256-0467
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 WESTWOOD DR STE 101
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79603-6828
Country	:	US
Telephone Number	:	325-244-5407
Fax Number	:	325-244-5597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	08/29/2023

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