Provider Demographics
NPI:1184281032
Name:KUYKENDALL, LETITIA
Entity type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:
Last Name:KUYKENDALL
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 1:1855 HILTON HEAD DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3423
Mailing Address - Country:US
Mailing Address - Phone:832-691-7225
Mailing Address - Fax:
Practice Address - Street 1:1855 HILTON HEAD DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3423
Practice Address - Country:US
Practice Address - Phone:832-691-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities