Provider Demographics
NPI:1164137501
Name:GUYMON, KYLIE DAWN
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:DAWN
Last Name:GUYMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W 100 S STE 100
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5840
Mailing Address - Country:US
Mailing Address - Phone:801-896-0793
Mailing Address - Fax:
Practice Address - Street 1:75 W 100 S STE 100
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5840
Practice Address - Country:US
Practice Address - Phone:801-896-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health