Provider Demographics
NPI:1134524135
Name:SELL, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SELL
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 1:6124 CROFTON DR
Mailing Address - Street 2:KDS HEALTH AND WELLNESS CONSULTING, LLC
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-8708
Mailing Address - Country:US
Mailing Address - Phone:260-413-3287
Mailing Address - Fax:
Practice Address - Street 1:6124 CROFTON DR
Practice Address - Street 2:KDS HEALTH AND WELLNESS CONSULTING, LLC
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-8708
Practice Address - Country:US
Practice Address - Phone:260-413-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst