Provider Demographics
NPI:1992259402
Name:GROSS, KENDRA RENEE (MED, LPCC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:RENEE
Last Name:GROSS
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-0802
Mailing Address - Country:US
Mailing Address - Phone:859-428-7862
Mailing Address - Fax:859-999-7869
Practice Address - Street 1:451 BIG HILL AVE STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-482-7862
Practice Address - Fax:859-999-7869
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168628101Y00000X, 101YM0800X
KY269446101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100728130Medicaid