Provider Demographics
NPI:1558022509
Name:KINKADE, LAUREN REBECCA (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:REBECCA
Last Name:KINKADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2082
Mailing Address - Country:US
Mailing Address - Phone:214-938-6000
Mailing Address - Fax:
Practice Address - Street 1:509 OXFORD ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2082
Practice Address - Country:US
Practice Address - Phone:214-938-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional