Provider Demographics
NPI:1043947138
Name:KENYATTA, TRESSA CLOYETTE
Entity type:Individual
Prefix:MRS
First Name:TRESSA
Middle Name:CLOYETTE
Last Name:KENYATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W GLENDALE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-9701
Mailing Address - Country:US
Mailing Address - Phone:602-314-4596
Mailing Address - Fax:
Practice Address - Street 1:1701 W GLENDALE AVE STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-9701
Practice Address - Country:US
Practice Address - Phone:602-314-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician