Provider Demographics
NPI:1578279592
Name:KUYKENDALL, ADAM J (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 WALNUT TRL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7053
Mailing Address - Country:US
Mailing Address - Phone:423-383-3328
Mailing Address - Fax:
Practice Address - Street 1:348 WALNUT TRL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7053
Practice Address - Country:US
Practice Address - Phone:423-383-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional