Provider Demographics
NPI:1578879623
Name:KINNE, KYLE DUWAYNE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:DUWAYNE
Last Name:KINNE
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 1:604 RUSHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2719
Mailing Address - Country:US
Mailing Address - Phone:515-386-4783
Mailing Address - Fax:
Practice Address - Street 1:106 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1952
Practice Address - Country:US
Practice Address - Phone:515-370-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health