Provider Demographics
NPI:1861038325
Name:KUNKLE, CARLY HOUSTON (LPC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:HOUSTON
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:HOUSTON
Other - Last Name:TIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:228 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4728
Mailing Address - Country:US
Mailing Address - Phone:412-537-8003
Mailing Address - Fax:
Practice Address - Street 1:121 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1068
Practice Address - Country:US
Practice Address - Phone:724-537-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional