Provider Demographics
NPI:1235620972
Name:KIRKSEY, CHENETTA (MA, LPC)
Entity type:Individual
Prefix:
First Name:CHENETTA
Middle Name:
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11816 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8011
Mailing Address - Country:US
Mailing Address - Phone:773-818-7337
Mailing Address - Fax:
Practice Address - Street 1:1401 COLETO CREEK TRL
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1546
Practice Address - Country:US
Practice Address - Phone:773-818-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty