Healthcare Provider Details

I. General information

NPI: 1962232603
Provider Name (Legal Business Name): KYLE R BRODY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 E PINNACLE PEAK RD
SCOTTSDALE AZ
85255-3406
US

IV. Provider business mailing address

24786 N 117TH ST
SCOTTSDALE AZ
85255-5900
US

V. Phone/Fax

Practice location:
  • Phone: 480-635-6679
  • Fax:
Mailing address:
  • Phone: 480-635-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC23144
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: