Provider Demographics
NPI:1376891788
Name:CANTRELL, KYLE BELVIN
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:BELVIN
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-4410
Mailing Address - Country:US
Mailing Address - Phone:405-990-8305
Mailing Address - Fax:
Practice Address - Street 1:520 E HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-4410
Practice Address - Country:US
Practice Address - Phone:405-990-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral