Healthcare Provider Details

I. General information

NPI: 1619480746
Provider Name (Legal Business Name): AMIE ELIZABETH KUYKENDALL LCSW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MEDICAL DR STE 117
SAN ANTONIO TX
78229-5623
US

IV. Provider business mailing address

4201 MEDICAL DR STE 117
SAN ANTONIO TX
78229-5623
US

V. Phone/Fax

Practice location:
  • Phone: 210-777-2138
  • Fax: 210-569-7770
Mailing address:
  • Phone: 210-777-2138
  • Fax: 210-569-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number54767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: