=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952173114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHEYENNE JEWEL KULHANEK LPC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 10/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8350 BLUFF SPRINGS RD UNIT 1217
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78744-6888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-441-2058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8350 BLUFF SPRINGS RD UNIT 1217
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78744-6888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-441-2058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 91116
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------