Provider Demographics
NPI:1184889149
Name:KUYKENDALL, IRIS L (MS, LPC, CRC)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:L
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:MS, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CARDINAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4960
Mailing Address - Country:US
Mailing Address - Phone:817-581-4730
Mailing Address - Fax:
Practice Address - Street 1:1050 CARDINAL RIDGE RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4960
Practice Address - Country:US
Practice Address - Phone:817-581-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60678101YP2500X
TX00056671225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600607151OtherBCBSTX
TX2012007Medicaid