Provider Demographics
NPI:1134015068
Name:MCKENNERY, KAYSHON RENEE (LPC)
Entity type:Individual
Prefix:
First Name:KAYSHON
Middle Name:RENEE
Last Name:MCKENNERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:R
Other - Last Name:MCKENNERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:605 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-2048
Mailing Address - Country:US
Mailing Address - Phone:512-592-9426
Mailing Address - Fax:817-768-9727
Practice Address - Street 1:605 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2048
Practice Address - Country:US
Practice Address - Phone:512-592-9426
Practice Address - Fax:817-768-9727
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional