Healthcare Provider Details

I. General information

NPI: 1578279592
Provider Name (Legal Business Name): ADAM J KUYKENDALL LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 WALNUT TRL
BRISTOL TN
37620-7053
US

IV. Provider business mailing address

348 WALNUT TRL
BRISTOL TN
37620-7053
US

V. Phone/Fax

Practice location:
  • Phone: 423-383-3328
  • Fax:
Mailing address:
  • Phone: 423-383-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6386
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: