Provider Demographics
NPI:1851896443
Name:LUNSFORD, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1118
Mailing Address - Country:US
Mailing Address - Phone:606-717-1024
Mailing Address - Fax:606-717-1048
Practice Address - Street 1:102 RIVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1118
Practice Address - Country:US
Practice Address - Phone:606-717-1024
Practice Address - Fax:606-717-1048
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid