Provider Demographics
NPI:1992911416
Name:HOLLIS, KENNETH ALLEN (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 BENNY RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-2005
Mailing Address - Country:US
Mailing Address - Phone:502-802-4980
Mailing Address - Fax:
Practice Address - Street 1:1143 S 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2901
Practice Address - Country:US
Practice Address - Phone:502-589-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 0616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist