Individual
MELBA JOYCE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
4101 S MEDFORD DR, LUFKIN, TX 75901-5633
(936) 639-1141
Mailing address
4101 S MEDFORD DR, LUFKIN, TX 75901-5633
(936) 639-1141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1739-1005
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8645BH
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/05/2006
Last updated
07/08/2007
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