Provider Demographics
NPI:1275031924
Name:KENNEY, TINA (LPCC-S)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15887 SNOW RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2854
Mailing Address - Country:US
Mailing Address - Phone:216-714-3128
Mailing Address - Fax:
Practice Address - Street 1:15887 SNOW RD STE 301
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2854
Practice Address - Country:US
Practice Address - Phone:216-714-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health