1881836922 NPI number — MRS. DONNA KENNEDY CARRASCO LPC, NCC

Table of content: MRS. DONNA KENNEDY CARRASCO LPC, NCC (NPI 1881836922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881836922 NPI number — MRS. DONNA KENNEDY CARRASCO LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRASCO
Provider First Name:
DONNA
Provider Middle Name:
KENNEDY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENNEDY
Provider Other First Name:
DONNA
Provider Other Middle Name:
ANETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881836922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 TOWER DR STE 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79761-4251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-210-5200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 TOWER DR STE 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-4251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-210-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  61890 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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