Provider Demographics
NPI:1942832092
Name:CAPPS, KYLIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:CAPPS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KERCHEVAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3635
Mailing Address - Country:US
Mailing Address - Phone:313-530-4456
Mailing Address - Fax:
Practice Address - Street 1:100 KERCHEVAL AVE STE D
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3635
Practice Address - Country:US
Practice Address - Phone:313-530-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011063471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical