Healthcare Provider Details

I. General information

NPI: 1760643324
Provider Name (Legal Business Name): JANET BOGGS KUYKENDALL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 N MARION AVE
LAKE CITY FL
32055-2863
US

IV. Provider business mailing address

248 N MARION AVE
LAKE CITY FL
32055-2863
US

V. Phone/Fax

Practice location:
  • Phone: 386-365-0885
  • Fax:
Mailing address:
  • Phone: 386-365-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 11653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: