Provider Demographics
NPI:1043788334
Name:VILLANUEVA, KYLE CLIFTON (LBSW)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:CLIFTON
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 UNIVERSITY HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-1219
Mailing Address - Country:US
Mailing Address - Phone:214-226-9174
Mailing Address - Fax:
Practice Address - Street 1:5300 UNIVERSITY HILLS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-1219
Practice Address - Country:US
Practice Address - Phone:214-226-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60645101YA0400X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)