Provider Demographics
NPI:1467818641
Name:STEPHENSON, KYLE R (PHD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:R
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1035
Mailing Address - Country:US
Mailing Address - Phone:513-745-3463
Mailing Address - Fax:
Practice Address - Street 1:3800 VICTORY PARKWAY
Practice Address - Street 2:ELET HALL, RM 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207
Practice Address - Country:US
Practice Address - Phone:513-745-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08315103TC0700X
OR22426103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral