Provider Demographics
NPI:1861818833
Name:EDQUIST, KYLE BRANDON (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:BRANDON
Last Name:EDQUIST
Suffix:
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 E HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1207
Mailing Address - Country:US
Mailing Address - Phone:714-408-1112
Mailing Address - Fax:
Practice Address - Street 1:1315 E HICKORY LN
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1207
Practice Address - Country:US
Practice Address - Phone:714-408-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health