Provider Demographics
NPI:1508547159
Name:SAMMONS, KYLE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COURT ST STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2358
Mailing Address - Country:US
Mailing Address - Phone:989-572-0246
Mailing Address - Fax:989-355-0719
Practice Address - Street 1:210 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2358
Practice Address - Country:US
Practice Address - Phone:989-572-0246
Practice Address - Fax:989-355-0719
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117079104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker