Provider Demographics
NPI:1811689433
Name:SKIDMORE, KAYLE (LPC)
Entity type:Individual
Prefix:
First Name:KAYLE
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 NOVA SCOTIA CT
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6284
Mailing Address - Country:US
Mailing Address - Phone:806-662-2872
Mailing Address - Fax:
Practice Address - Street 1:719 S AUSTIN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6714
Practice Address - Country:US
Practice Address - Phone:806-662-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health