Healthcare Provider Details

I. General information

NPI: 1265972194
Provider Name (Legal Business Name): JENNIFER CUYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2017
Last Update Date: 02/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S VIRGINIA HILLS DR UNIT 1702
MCKINNEY TX
75070-8961
US

IV. Provider business mailing address

575 S VIRGINIA HILLS DR UNIT 1702
MCKINNEY TX
75070-8961
US

V. Phone/Fax

Practice location:
  • Phone: 469-815-5115
  • Fax:
Mailing address:
  • Phone: 469-815-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70219
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: