Provider Demographics
NPI:1619680402
Name:KYLE, STEPHANIE CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:KYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 E ROOSEVELT ST
Mailing Address - Street 2:ATTN: MANAGED CARE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8088 W WHITNEY DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6564
Practice Address - Country:US
Practice Address - Phone:602-655-2000
Practice Address - Fax:602-655-2202
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-209511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical