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NPI Code Detail

MEDICARE: CRYSTAL KENNEDY LPC-S

MEDICARE: CRYSTAL KENNEDY LPC-S
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
1101YP2500XProfessional Counselor4546LA

General Provider Information

NPI Number : 1881061133
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL KENNEDY LPC-S
Provider Business Mailing Address
First Line : 710 VERSAILLES BLVD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-2351
Country : US
Telephone Number : 337-456-7880
Fax Number : 337-456-7882
Provider Business Practice Location Address
First Line : 222 RUE DE JEAN
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3388
Country : US
Telephone Number : 337-456-7880
Fax Number : 337-456-7882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2015
Last Update Date : 04/20/2023

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Directions to “ CRYSTAL KENNEDY LPC-S” Practice Location

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