Provider Demographics
NPI:1083819106
Name:STILL, KYLE KIMBRIEL (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:KIMBRIEL
Last Name:STILL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:KIMBRIEL
Other - Last Name:STILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1046
Mailing Address - Country:US
Mailing Address - Phone:662-627-7267
Mailing Address - Fax:
Practice Address - Street 1:1459 MAIN ST
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676
Practice Address - Country:US
Practice Address - Phone:662-636-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health