Provider Demographics
NPI:1588235584
Name:RUTHERFORD, KYLE HUNTER
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:HUNTER
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BELLA MONTAGNA CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2666
Mailing Address - Country:US
Mailing Address - Phone:818-648-4584
Mailing Address - Fax:
Practice Address - Street 1:19019 STATE HIGHWAY 71 W
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6468
Practice Address - Country:US
Practice Address - Phone:512-646-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician