Active NPI
Derryl Kinnell
- Professional Counselor
- Wylie, TX
National Provider Identifier
1346063500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 97009
- Practice address
- 303 S State Highway 78
Ste 103
Wylie, TX 75098 - Phone
- (469) 342-3468
- NPI assigned
- Nov 6, 2024
- Last updated
- Nov 6, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 97009 | TX | Primary |
Addresses
Primary practice location
303 S State Highway 78
Ste 103
Wylie, TX 75098
Mailing address
2300 S McDonald St Apt 211
McKinney, TX 75069-1587
Phone (214) 945-9095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 97009 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CCNT Inc. | Current | Accepting new patients |
Locations
303 S Highway 78
Ste 103
Wylie, TX 75098
Phone (469) 342-3468
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730851200000",
"number": "1346063500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 S MCDONALD ST APT 211",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750691587",
"telephone_number": "214-945-9095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 S STATE HIGHWAY 78",
"address_2": "STE 103",
"city": "WYLIE",
"state": "TX",
"postal_code": "75098",
"telephone_number": "469-342-3468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNELL",
"first_name": "DERRYL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-06",
"last_updated": "2024-11-06",
"certification_date": "2024-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "97009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wylie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.