MEDICARE: DANIELLE DOLORES KUYKENDALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164668794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE DOLORES KUYKENDALL

Provider Business Mailing Address
First Line	:	609 FOX HILL DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-7349
Country	:	US
Telephone Number	:	405-823-1014
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 HWY 66
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-5104
Country	:	US
Telephone Number	:	405-262-3209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2009
Last Update Date	:	01/23/2009

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