Provider Demographics
NPI:1437503398
Name:KEANE, KYLE MCGREGOR (LPC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MCGREGOR
Last Name:KEANE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SAINT CHARLES AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4705
Mailing Address - Country:US
Mailing Address - Phone:770-841-1999
Mailing Address - Fax:
Practice Address - Street 1:3355 LENOX ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1394
Practice Address - Country:US
Practice Address - Phone:770-841-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional