Individual provider Active NPI

Amanda McDonald Kennard, LMHC

  • Mental Health Counselor
  • Punta Gorda, FL
National Provider Identifier
1275719171
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH 9262 Issued in FL
Practice address
207 Cross St
Ste 103
Punta Gorda, FL 33950-4445
Phone
(941) 916-5291
NPI assigned
Jan 10, 2008
Last updated
Apr 18, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH 9262 FL Primary

Addresses

Primary practice location

207 Cross St
Ste 103
Punta Gorda, FL 33950-4445

Mailing address

4108 Bruing St
North Port, FL 34286-2461
Phone (941) 916-5291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240111001088 FL Practitioner - Mental Health Counselor 0143686212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4108 Bruing St
North Port, FL 34286-2461
Phone (941) 916-5291

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH 9262FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Psych-Ed Services Inc. Mental Health CurrentSince Jan 27, 2023 Accepting new patients
Shawnee Mental Health Center, Inc. Past Accepting new patients
Shawnee Mental Health Center, Inc. Past Accepting new patients
Shawnee Mental Health Center, Inc. Past Accepting new patients

Locations

207 Cross St
Ste 103
Punta Gorda, FL 33950
Phone (941) 916-5291

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460937600000",
    "number": "1275719171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4108 BRUING ST",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342862461",
            "telephone_number": "941-916-5291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 CROSS ST",
            "address_2": "STE 103",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339504445",
            "telephone_number": "941-916-5291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNARD",
        "first_name": "AMANDA",
        "middle_name": "MCDONALD",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-10",
        "last_updated": "2016-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 9262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Punta Gorda, FL

Sources for this page

Verify at the official NPI Registry.