Provider Demographics
NPI:1205017068
Name:STINSON, KYLE (LSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:STINSON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ERIN CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8591
Mailing Address - Country:US
Mailing Address - Phone:937-393-2518
Mailing Address - Fax:
Practice Address - Street 1:108 ERIN CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8591
Practice Address - Country:US
Practice Address - Phone:937-393-2518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS14766104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker