Individual
KELLY KENNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, MFT
Contact information
Practice address
1680 NAVE RD SE, MASSILLON, OH 44646
(330) 830-8740
(330) 830-0912
Mailing address
625 CLEVELAND AVE NW, CANTON, OH 44702-1805
(330) 455-0374
(330) 453-6716
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C1801257
OH
106H00000X
Marriage & Family Therapist
M.1800071
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0291227
—
OH
Enumeration date
04/17/2018
Last updated
02/20/2019
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