Healthcare Provider Details

I. General information

NPI: 1558766469
Provider Name (Legal Business Name): ZAYA KUYKENDALL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZAYA KUYKENDALL-BOWEN LMHC

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 W 162ND ST APT. 1R
NEW YORK NY
10032-6039
US

IV. Provider business mailing address

PO BOX 212
NEW YORK NY
10032-0212
US

V. Phone/Fax

Practice location:
  • Phone: 917-409-8190
  • Fax:
Mailing address:
  • Phone: 917-409-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26006
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005925
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: