Provider Demographics
NPI:1811602097
Name:HARRIS, KYLE CHRISTOPHER (MA, LPC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:HARRIS
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 W AVENTURA WAY APT 8116
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3139
Mailing Address - Country:US
Mailing Address - Phone:773-556-0593
Mailing Address - Fax:
Practice Address - Street 1:485 WILDWOOD PKWY
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2653
Practice Address - Country:US
Practice Address - Phone:314-252-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022045290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional