Healthcare Provider Details

I. General information

NPI: 1457827826
Provider Name (Legal Business Name): JAYLEE CUNNINGHAM MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAQUELYN CUNNINGHAM MA, LMFT

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 E REYNOLDS RD STE 101
LEXINGTON KY
40517-1270
US

IV. Provider business mailing address

169 E REYNOLDS RD STE 100A
LEXINGTON KY
40517-1272
US

V. Phone/Fax

Practice location:
  • Phone: 859-279-2949
  • Fax: 502-323-0749
Mailing address:
  • Phone: 859-279-2949
  • Fax: 502-323-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number273964
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number273964
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: