Provider Demographics
NPI:1053596742
Name:NEAL, KENNETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:NEAL
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8321 TROUBADOUR WAY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7026
Mailing Address - Country:US
Mailing Address - Phone:706-455-5725
Mailing Address - Fax:
Practice Address - Street 1:8321 TROUBADOUR WAY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7026
Practice Address - Country:US
Practice Address - Phone:706-455-5725
Practice Address - Fax:706-632-3585
Is Sole Proprietor?:No
Enumeration Date:2008-01-01
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical