Provider Demographics
NPI:1073899910
Name:LASLEY, KYLE L (MA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:L
Last Name:LASLEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2138
Mailing Address - Country:US
Mailing Address - Phone:719-384-5446
Mailing Address - Fax:719-384-5672
Practice Address - Street 1:1049 KANSAS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1823
Practice Address - Country:US
Practice Address - Phone:719-523-4889
Practice Address - Fax:719-523-0146
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health