Provider Demographics
NPI:1972381333
Name:HEWARD, KYLE ALEXANDER
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALEXANDER
Last Name:HEWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 21ST AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1547
Mailing Address - Country:US
Mailing Address - Phone:208-312-7874
Mailing Address - Fax:
Practice Address - Street 1:3263 FRASER ST STE 3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1245
Practice Address - Country:US
Practice Address - Phone:303-371-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COINTERN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist