Provider Demographics
NPI:1023359676
Name:COLE, KYLIE GRAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:GRAY
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0827
Mailing Address - Country:US
Mailing Address - Phone:207-852-2204
Mailing Address - Fax:207-848-2498
Practice Address - Street 1:2344 UNION ST
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0827
Practice Address - Country:US
Practice Address - Phone:207-852-2204
Practice Address - Fax:207-848-2498
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist