Provider Demographics
NPI:1023395464
Name:STANSBURY, KYLE (LCSW)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:STANSBURY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-3426
Mailing Address - Country:US
Mailing Address - Phone:406-530-9977
Mailing Address - Fax:
Practice Address - Street 1:77 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:21275-9194
Practice Address - Country:US
Practice Address - Phone:406-530-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT180401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical