Basic Information
| Provider Information | |||||||||
| NPI: | 1083819106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STILL | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | KIMBRIEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED., LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STILL | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | KIMBRIEL | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1046 | ||||||||
| Address2: | |||||||||
| City: | CLARKSDALE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386141046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626277267 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1459 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TUNICA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626363222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 09/12/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1270 | MS | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.