Provider Demographics
NPI:1144997677
Name:THOMPSON, KYLE ANTHONY (LPCA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANTHONY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MCCREADY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2751
Mailing Address - Country:US
Mailing Address - Phone:502-693-9722
Mailing Address - Fax:
Practice Address - Street 1:307 MCCREADY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2751
Practice Address - Country:US
Practice Address - Phone:502-693-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional