Provider Demographics
NPI:1851447916
Name:WEIR, KYLE N (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:N
Last Name:WEIR
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29795 KINGS CANYON CT S
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9580
Mailing Address - Country:US
Mailing Address - Phone:559-658-8842
Mailing Address - Fax:
Practice Address - Street 1:CSU FRESNO DEPT OF CSER
Practice Address - Street 2:5005 N. MAPLE AVE. MS ED 3
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-0169
Practice Address - Fax:559-278-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44063106H00000X
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist