Healthcare Provider Details

I. General information

NPI: 1922845270
Provider Name (Legal Business Name): KYLE EVAN BACON PSYD, LP, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 THORNTON PKWY UNIT 234
THORNTON CO
80229-2167
US

IV. Provider business mailing address

1541 WABASH ST
DENVER CO
80220-2143
US

V. Phone/Fax

Practice location:
  • Phone: 720-459-7493
  • Fax:
Mailing address:
  • Phone: 720-468-9654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0006420
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60816
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: