Active NPI
Mark Alan Kunkel, PH.D.
- Counseling Psychologist
- Carrollton, GA
National Provider Identifier
1447496385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 001952
- Practice address
- 309 Tanner St
Carrollton, GA 30117-3207 - Phone
- (678) 571-4126
- NPI assigned
- Dec 24, 2008
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 001952 | GA | Primary |
Addresses
Primary practice location
309 Tanner St
Carrollton, GA 30117-3207
Mailing address
309 Tanner St
Carrollton, GA 30117-3207
Phone (678) 571-4126
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 331634834A | Medicaid | GA |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001952 | GA | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230076800000",
"number": "1447496385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 TANNER ST",
"city": "CARROLLTON",
"state": "GA",
"postal_code": "301173207",
"telephone_number": "678-571-4126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 TANNER ST",
"city": "CARROLLTON",
"state": "GA",
"postal_code": "301173207",
"telephone_number": "678-571-4126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNKEL",
"first_name": "MARK",
"middle_name": "ALAN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-24",
"last_updated": "2008-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "GA",
"license": "001952",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "331634834A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.