Provider Demographics
NPI:1194486977
Name:KENNEDY, CASSONDRA JO (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CASSONDRA
Middle Name:JO
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 CADENCE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5407
Mailing Address - Country:US
Mailing Address - Phone:775-682-1230
Mailing Address - Fax:
Practice Address - Street 1:1489 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7635
Practice Address - Country:US
Practice Address - Phone:702-748-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist