Provider Demographics
NPI:1154001212
Name:KENNEY, TABATHA FRANKLIN
Entity type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:FRANKLIN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 KINSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4185
Mailing Address - Country:US
Mailing Address - Phone:601-946-4632
Mailing Address - Fax:
Practice Address - Street 1:617 KINSINGTON CT
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4185
Practice Address - Country:US
Practice Address - Phone:601-946-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional