Provider Demographics
NPI:1902170574
Name:KING, KYLE STEPHANIE (LMFT, LCPC)
Entity Type:Individual
Prefix:MS
First Name:KYLE
Middle Name:STEPHANIE
Last Name:KING
Suffix:
Gender:F
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W PANORAMA DR
Mailing Address - Street 2:APT 209
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-0621
Mailing Address - Country:US
Mailing Address - Phone:224-636-1212
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:SUITE 305A
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1444
Practice Address - Country:US
Practice Address - Phone:224-636-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007197101YP2500X
IL166000721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist