Basic Information
| Provider Information | |||||||||
| NPI: | 1619001344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOTT | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 436 GREEN ACRES ST | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637017013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734710800 | ||||||||
| FaxNumber: | 5734710810 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 PLANTATION BLVD | ||||||||
| Address2: | |||||||||
| City: | SIKESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638015736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734710800 | ||||||||
| FaxNumber: | 5734710810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1999142312 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.