Provider Demographics
NPI:1033458716
Name:TINSLEY, KENDYL (MS, LPC-S)
Entity Type:Individual
Prefix:
First Name:KENDYL
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:MS, LPC-S
Other - Prefix:
Other - First Name:KENDYL
Other - Middle Name:DAWN
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-8705
Mailing Address - Country:US
Mailing Address - Phone:479-841-5323
Mailing Address - Fax:
Practice Address - Street 1:711 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2733
Practice Address - Country:US
Practice Address - Phone:870-433-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1804049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR231726719Medicaid
MO490082119Medicaid