Provider Demographics
NPI:1578294823
Name:KINKADE, KRISTIN KAY (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAY
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 1:201 NW 101ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-1799
Mailing Address - Country:US
Mailing Address - Phone:816-876-4275
Mailing Address - Fax:
Practice Address - Street 1:201 NW 101ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-1799
Practice Address - Country:US
Practice Address - Phone:816-876-4275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010011760101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor