Provider Demographics
NPI:1699459511
Name:KENNARD, NATASHA MARIE
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:KENNARD
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 1:793 S TRACY BLVD # 376
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4753
Mailing Address - Country:US
Mailing Address - Phone:209-207-2597
Mailing Address - Fax:
Practice Address - Street 1:35 E 10TH ST STE K
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4058
Practice Address - Country:US
Practice Address - Phone:209-627-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health