Provider Demographics
NPI:1730452939
Name:KENNEDY, DENNIS S (LMFT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:S
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N WATER ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3853
Mailing Address - Country:US
Mailing Address - Phone:316-267-3825
Mailing Address - Fax:316-267-3843
Practice Address - Street 1:731 N WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3853
Practice Address - Country:US
Practice Address - Phone:316-267-3825
Practice Address - Fax:316-267-3843
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07470984101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100320580AMedicaid