Provider Demographics
NPI:1588133110
Name:MCMINN, KENLEIGH RODEN (PHD)
Entity type:Individual
Prefix:
First Name:KENLEIGH
Middle Name:RODEN
Last Name:MCMINN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1804
Mailing Address - Country:US
Mailing Address - Phone:214-820-5516
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVENUE
Practice Address - Street 2:BARNETT TOWER, SUITE 404
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-820-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009979103TC0700X
TX38336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical