Provider Demographics
NPI:1134676802
Name:PHELPS, KYLIE (LPC)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:NICOLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-2717
Mailing Address - Country:US
Mailing Address - Phone:512-298-4854
Mailing Address - Fax:512-298-4854
Practice Address - Street 1:3033 CAMPUS DR STE W225
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55441-2752
Practice Address - Country:US
Practice Address - Phone:415-504-3838
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022029205101Y00000X
CO0017923101Y00000X
TX70475101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor