Provider Demographics
NPI:1558747014
Name:TAPP, KENDALL L (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:L
Last Name:TAPP
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:L
Other - Last Name:FIELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7757
Mailing Address - Country:US
Mailing Address - Phone:270-302-1408
Mailing Address - Fax:
Practice Address - Street 1:1925 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00221275101YM0800X
KYLPCCCA00221275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health