MEDICARE: KENDRA TEVIS LCSW

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	1041C0700X	Clinical Social Worker	40770	TX

General Provider Information

NPI Number	:	1821757907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA TEVIS LCSW

Provider Business Mailing Address
First Line	:	228 CLIFF HEIGHTS CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5331
Country	:	US
Telephone Number	:	469-583-4592
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 CLIFF HEIGHTS CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5331
Country	:	US
Telephone Number	:	469-583-4592
Fax Number	:

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

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	12/15/2021

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Directions to “ KENDRA TEVIS LCSW” Practice Location

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