Provider Demographics
NPI:1104204551
Name:KENNISON, ALEXANDER (LMFT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KENNISON
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 1:2135 NW 108TH ST UNIT 71591
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-3826
Mailing Address - Country:US
Mailing Address - Phone:515-346-3069
Mailing Address - Fax:515-346-3069
Practice Address - Street 1:5550 WILD ROSE LN STE 400
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5351
Practice Address - Country:US
Practice Address - Phone:515-346-3069
Practice Address - Fax:515-346-3069
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist