Provider Demographics
NPI:1992045413
Name:KYLE, CARL WALTER (LMHC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:WALTER
Last Name:KYLE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11428 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1829
Mailing Address - Country:US
Mailing Address - Phone:904-493-2127
Mailing Address - Fax:
Practice Address - Street 1:11428 MCCORMICK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-1829
Practice Address - Country:US
Practice Address - Phone:904-493-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-6378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health