Provider Demographics
NPI:1700913506
Name:TICK, KYLE BETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:BETH
Last Name:TICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30702 ELDORA CT
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9409
Mailing Address - Country:US
Mailing Address - Phone:720-363-8191
Mailing Address - Fax:
Practice Address - Street 1:1325 S COLORADO BLVD # B108
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3033
Practice Address - Country:US
Practice Address - Phone:720-363-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health