1083819106 NPI number — MRS. KYLE KIMBRIEL STILL M.ED., LPC

Table of content: MRS. KYLE KIMBRIEL STILL M.ED., LPC (NPI 1083819106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083819106 NPI number — MRS. KYLE KIMBRIEL STILL M.ED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILL
Provider First Name:
KYLE
Provider Middle Name:
KIMBRIEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STILL
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
KIMBRIEL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1083819106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSDALE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38614-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-627-7267
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1459 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNICA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-636-3222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1270 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com