Provider Demographics
NPI:1043871551
Name:BROWN, KYLE BURTON (MS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:BURTON
Last Name:BROWN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SW EMKAY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3162
Mailing Address - Country:US
Mailing Address - Phone:928-380-1206
Mailing Address - Fax:
Practice Address - Street 1:1011 SW EMKAY DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3162
Practice Address - Country:US
Practice Address - Phone:541-343-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist