Provider Demographics
NPI:1578846275
Name:GERRY, KYLE PATRICK (LMHC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:PATRICK
Last Name:GERRY
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 1:14090 FRYELANDS BLVD SE STE 234
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2763
Mailing Address - Country:US
Mailing Address - Phone:425-243-6153
Mailing Address - Fax:
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 234
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2763
Practice Address - Country:US
Practice Address - Phone:425-243-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60813341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health