Provider Demographics
NPI:1730433442
Name:O'CONNELL, KYLE JOHN
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOHN
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-9715
Mailing Address - Country:US
Mailing Address - Phone:303-258-3613
Mailing Address - Fax:
Practice Address - Street 1:1070 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466-9715
Practice Address - Country:US
Practice Address - Phone:303-258-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker