Provider Demographics
NPI:1588005870
Name:HANES, KYLE J (MED, LBA, BCBA,LPC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:J
Last Name:HANES
Suffix:
Gender:M
Credentials:MED, LBA, BCBA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 HELMIC RD
Mailing Address - Street 2:
Mailing Address - City:APPLE SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75926-5932
Mailing Address - Country:US
Mailing Address - Phone:936-404-3679
Mailing Address - Fax:
Practice Address - Street 1:814 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3812
Practice Address - Country:US
Practice Address - Phone:936-404-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68436101YP2500X
TX2362103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional