Provider Demographics
NPI:1689124737
Name:FELIX, KYLIE TARA JEAN (CSW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:TARA JEAN
Last Name:FELIX
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 E 1270 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6527
Mailing Address - Country:US
Mailing Address - Phone:714-391-4141
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST
Practice Address - Street 2:# 10
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4013
Practice Address - Country:US
Practice Address - Phone:801-358-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10089224-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical