Provider Demographics
NPI:1457827826
Name:CUNNINGHAM, JAYLEE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JAYLEE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:JAQUELYN
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:169 E REYNOLDS RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1272
Mailing Address - Country:US
Mailing Address - Phone:859-279-2949
Mailing Address - Fax:502-323-0749
Practice Address - Street 1:169 E REYNOLDS RD STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1270
Practice Address - Country:US
Practice Address - Phone:859-279-2949
Practice Address - Fax:502-323-0749
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273964106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457827826OtherNPI- TYPE 1