Healthcare Provider Details

I. General information

NPI: 1891685434
Provider Name (Legal Business Name): KAYLEE TINKEY LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEE CLIDENCE LMHCA

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W STATE ST
PENDLETON IN
46064-1063
US

IV. Provider business mailing address

207 W STATE ST
PENDLETON IN
46064-1063
US

V. Phone/Fax

Practice location:
  • Phone: 765-221-9495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88002087A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: