Provider Demographics
NPI:1336599877
Name:HIGGINS, KYLE (RPH, LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:RPH, LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SILVER MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2380
Mailing Address - Country:US
Mailing Address - Phone:440-830-3405
Mailing Address - Fax:
Practice Address - Street 1:2101 SILVER MAPLE WAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2380
Practice Address - Country:US
Practice Address - Phone:440-830-3405
Practice Address - Fax:440-808-0800
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150058101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor