Provider Demographics
NPI:1619001344
Name:SCHOTT, KYLE J (LPC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:J
Last Name:SCHOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 GREEN ACRES ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-7013
Mailing Address - Country:US
Mailing Address - Phone:573-471-0800
Mailing Address - Fax:573-471-0810
Practice Address - Street 1:402 S SILVER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7536
Practice Address - Country:US
Practice Address - Phone:573-334-1100
Practice Address - Fax:573-651-4345
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999142312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494736705Medicaid