MEDICARE: LINDLEY KUNCE PPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PPC-1485	WY

General Provider Information

NPI Number	:	1609727395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDLEY KUNCE PPC

Provider Business Mailing Address
First Line	:	PO BOX 10123
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-0123
Country	:	US
Telephone Number	:	602-635-8485
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 E BROADWAY AVE
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8636
Country	:	US
Telephone Number	:	602-635-8485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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