Healthcare Provider Details

I. General information

NPI: 1679018436
Provider Name (Legal Business Name): TALIA KUYKENDALL MA, LMHC, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 SW 320TH ST
FEDERAL WAY WA
98023-2292
US

IV. Provider business mailing address

3430 SW 320TH ST
FEDERAL WAY WA
98023-2292
US

V. Phone/Fax

Practice location:
  • Phone: 253-289-6099
  • Fax: 253-231-7251
Mailing address:
  • Phone: 253-289-6099
  • Fax: 253-231-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60297550
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61025085
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: