Provider Demographics
NPI:1780025049
Name:REID, KYLE M JR (AMFT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:REID
Suffix:JR
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 S HIGHLAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2600
Mailing Address - Country:US
Mailing Address - Phone:801-272-3200
Mailing Address - Fax:
Practice Address - Street 1:4190 S HIGHLAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-2600
Practice Address - Country:US
Practice Address - Phone:801-272-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8357661-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist