Healthcare Provider Details

I. General information

NPI: 1205714656
Provider Name (Legal Business Name): TENESHIA KUYKENDOLL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

IV. Provider business mailing address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-0073
  • Fax: 708-681-3958
Mailing address:
  • Phone: 708-681-0073
  • Fax: 708-681-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: