Provider Demographics
NPI:1780109538
Name:KINZER, DAVID ALLEN (MCOUN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:KINZER
Suffix:
Gender:M
Credentials:MCOUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4224
Mailing Address - Country:US
Mailing Address - Phone:541-280-7822
Mailing Address - Fax:
Practice Address - Street 1:1922 ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4224
Practice Address - Country:US
Practice Address - Phone:541-280-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-13
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional