Provider Demographics
NPI:1952078693
Name:KUNKLE, KIERA MCGINLEY (MA)
Entity Type:Individual
Prefix:MS
First Name:KIERA
Middle Name:MCGINLEY
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 ORLEANS ST APT 1610
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2950
Mailing Address - Country:US
Mailing Address - Phone:412-715-5790
Mailing Address - Fax:
Practice Address - Street 1:107 E MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1566
Practice Address - Country:US
Practice Address - Phone:248-764-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000256103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist