Provider Demographics
NPI:1790155968
Name:DENNISON, KYLE DONALD (PSYD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DONALD
Last Name:DENNISON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7206
Mailing Address - Country:US
Mailing Address - Phone:800-287-2680
Mailing Address - Fax:253-476-6547
Practice Address - Street 1:4301 S PINE ST STE 301
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7206
Practice Address - Country:US
Practice Address - Phone:800-287-2680
Practice Address - Fax:253-476-6547
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
KY276359103T00000X
WAPY61444148103T00000X
WA61444148103T00000X
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