Provider Demographics
NPI:1740872555
Name:SKILES, KEVIN A (CMHC STUDENT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:SKILES
Suffix:
Gender:M
Credentials:CMHC STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3909
Mailing Address - Country:US
Mailing Address - Phone:808-347-8525
Mailing Address - Fax:724-503-6345
Practice Address - Street 1:3038 BROOKSTONE DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-3909
Practice Address - Country:US
Practice Address - Phone:808-347-8525
Practice Address - Fax:724-503-6345
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor