Provider Demographics
NPI:1609474899
Name:MULDER, KENDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:MULDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4540
Mailing Address - Country:US
Mailing Address - Phone:859-429-3081
Mailing Address - Fax:
Practice Address - Street 1:4533 WALNUT CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4540
Practice Address - Country:US
Practice Address - Phone:859-429-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2022-04-29
Deactivation Date:2022-04-05
Deactivation Code:
Reactivation Date:2022-04-29
Provider Licenses
StateLicense IDTaxonomies
KY254150101YM0800X
KY2566861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health