Provider Demographics
NPI:1437845534
Name:SHORE, KYLE WILLIAM (LMHC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:WILLIAM
Last Name:SHORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3766 CINNAMON WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5718
Mailing Address - Country:US
Mailing Address - Phone:567-281-0577
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL DR STE D
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2985
Practice Address - Country:US
Practice Address - Phone:317-281-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001902A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health