Provider Demographics
NPI:1679018436
Name:KUYKENDALL, TALIA (MA, LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:MA, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 SW 320TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2292
Mailing Address - Country:US
Mailing Address - Phone:253-289-6099
Mailing Address - Fax:253-231-7251
Practice Address - Street 1:3430 SW 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2292
Practice Address - Country:US
Practice Address - Phone:253-289-6099
Practice Address - Fax:253-231-7251
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60297550101YA0400X
WALH61025085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty