Provider Demographics
NPI:1205410016
Name:STOUGH, KYLIE DEANNA (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:DEANNA
Last Name:STOUGH
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 CHOTO MILL LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-0615
Mailing Address - Country:US
Mailing Address - Phone:865-392-1600
Mailing Address - Fax:
Practice Address - Street 1:240 W TYRONE RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6517
Practice Address - Country:US
Practice Address - Phone:865-481-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN228872163WG0000X
TN4660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice