Provider Demographics
NPI:1316379449
Name:TAVERNIER, KYE YVETTE (LMSW, LCDC)
Entity Type:Individual
Prefix:
First Name:KYE
Middle Name:YVETTE
Last Name:TAVERNIER
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 CROWNOVER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-4752
Mailing Address - Country:US
Mailing Address - Phone:510-414-3026
Mailing Address - Fax:
Practice Address - Street 1:3112 CROWNOVER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78725-4752
Practice Address - Country:US
Practice Address - Phone:510-414-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11356101YA0400X
TX57853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health