Provider Demographics
NPI:1093473944
Name:SUMMERS, KYLE (MED)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50005 E ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-8326
Mailing Address - Country:US
Mailing Address - Phone:720-563-9871
Mailing Address - Fax:
Practice Address - Street 1:50005 E ORCHARD RD
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-8326
Practice Address - Country:US
Practice Address - Phone:720-563-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-19-36702103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst