Provider Demographics
NPI:1568934776
Name:SMYTH, KYLE JAMES (LPCC, LADC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JAMES
Last Name:SMYTH
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 4TH ST E APT 1122
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2524
Mailing Address - Country:US
Mailing Address - Phone:651-207-9860
Mailing Address - Fax:
Practice Address - Street 1:7766 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2832
Practice Address - Country:US
Practice Address - Phone:763-205-4843
Practice Address - Fax:612-416-2085
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305110101YA0400X
MN4377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)