Provider Demographics
NPI:1669618625
Name:HUNNICUTT, KAYLEIGH (PHD)
Entity type:Individual
Prefix:DR
First Name:KAYLEIGH
Middle Name:
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3474
Mailing Address - Country:US
Mailing Address - Phone:419-870-0560
Mailing Address - Fax:
Practice Address - Street 1:4625 MORSE RD STE 200
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8355
Practice Address - Country:US
Practice Address - Phone:614-383-8381
Practice Address - Fax:855-259-2615
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08367103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherOTHER