Provider Demographics
NPI:1225373913
Name:KYLE, COURTNEY ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:KYLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 KELLETT PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 E MAIN ST
Practice Address - Street 2:ROOM 130
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2832
Practice Address - Country:US
Practice Address - Phone:864-878-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic