Provider Demographics
NPI:1326232273
Name:BILLINGSLEY, KYLIE ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:ANNE
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ANNE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1777 BOREL PLACE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:408-857-5489
Mailing Address - Fax:
Practice Address - Street 1:1400 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-299-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY23167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL231670OtherBLUE SHIELD OF CA