Provider Demographics
NPI:1467150920
Name:KUCHYNKA, KELSEY SABRINA (LAC)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:SABRINA
Last Name:KUCHYNKA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 E CLOUD RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5620
Mailing Address - Country:US
Mailing Address - Phone:480-335-5912
Mailing Address - Fax:
Practice Address - Street 1:2111 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4741
Practice Address - Country:US
Practice Address - Phone:602-456-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health