MEDICARE: JAYLEE CUNNINGHAM MA, LMFT

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	106H00000X	Marriage & Family Therapist	273964	KY
2	101YM0800X	Mental Health Counselor	273964	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457827826	OTHER		NPI- TYPE 1

General Provider Information

NPI Number	:	1457827826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLEE CUNNINGHAM MA, LMFT

Provider Business Mailing Address
First Line	:	169 E REYNOLDS RD STE 100A
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1272
Country	:	US
Telephone Number	:	859-279-2949
Fax Number	:	502-323-0749

Provider Business Practice Location Address
First Line	:	169 E REYNOLDS RD STE 101
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1270
Country	:	US
Telephone Number	:	859-279-2949
Fax Number	:	502-323-0749

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

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	01/22/2024

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