Provider Demographics
NPI:1265954796
Name:GORE-HALL, KYLIE RAE (PSYD, MS, LP, LPC-S)
Entity type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:RAE
Last Name:GORE-HALL
Suffix:
Gender:F
Credentials:PSYD, MS, LP, LPC-S
Other - Prefix:DR
Other - First Name:KYLIE
Other - Middle Name:RAE
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, MS, LP, LPC-S
Mailing Address - Street 1:530 7TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4971
Mailing Address - Country:US
Mailing Address - Phone:907-451-8208
Mailing Address - Fax:907-451-8207
Practice Address - Street 1:530 7TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4971
Practice Address - Country:US
Practice Address - Phone:907-451-8208
Practice Address - Fax:907-451-8207
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157795101YM0800X
390200000X
AK210008103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program