Provider Demographics
NPI:1750194486
Name:STRUNK, KYLE JORDAN (TLBA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JORDAN
Last Name:STRUNK
Suffix:
Gender:M
Credentials:TLBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COLLEGE ST STE D
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1307
Mailing Address - Country:US
Mailing Address - Phone:606-677-2636
Mailing Address - Fax:
Practice Address - Street 1:105 COLLEGE ST STE D
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1307
Practice Address - Country:US
Practice Address - Phone:606-677-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY297048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty