Active NPI
Mary Katherine Kenworthy, LMSW
- Mental Health Counselor
- Dallas, TX
National Provider Identifier
1548506645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 56270
- Practice address
- 4500 S Lancaster Rd
Gold Team 116a
Dallas, TX 75216-7167 - Phone
- (214) 742-8387
- Fax
- (214) 857-0789
- NPI assigned
- Dec 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 56270 | TX | |
| Mental Health Counselor | 101YM0800X | 56270 | TX | Primary |
Addresses
Primary practice location
4500 S Lancaster Rd
Gold Team 116a
Dallas, TX 75216-7167
Mailing address
4500 S Lancaster Rd
Dallas, TX 75216-7167
Phone (214) 742-8387
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56270 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355702400000",
"number": "1548506645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 S LANCASTER RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752167167",
"telephone_number": "214-742-8387",
"fax_number": "221-485-7078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 S LANCASTER RD",
"address_2": "GOLD TEAM 116A",
"city": "DALLAS",
"state": "TX",
"postal_code": "752167167",
"telephone_number": "214-742-8387",
"fax_number": "214-857-0789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENWORTHY",
"first_name": "MARY",
"middle_name": "KATHERINE",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-17",
"last_updated": "2012-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "56270",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "56270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.