Provider Demographics
NPI:1134664188
Name:LEWIS, KYLE (LMFT, APCC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4511
Mailing Address - Country:US
Mailing Address - Phone:619-780-4242
Mailing Address - Fax:
Practice Address - Street 1:127 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4511
Practice Address - Country:US
Practice Address - Phone:619-780-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAAMFT106731101YM0800X, 106H00000X
CA121395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health