Healthcare Provider Details

I. General information

NPI: 1891875266
Provider Name (Legal Business Name): KYLE V MCCARD LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 KENYON RD NORTH CENTRAL IOWA MHC DBA BERRYHILL CENTER FOR MENTAL
FORT DODGE IA
50501-5759
US

IV. Provider business mailing address

720 KENYON RD NORTH CENTRAL IOWA MHC DBA BERRYHILL CENTER FOR MENTAL
FORT DODGE IA
50501-5759
US

V. Phone/Fax

Practice location:
  • Phone: 515-955-7171
  • Fax: 515-573-7898
Mailing address:
  • Phone: 515-955-7171
  • Fax: 515-573-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00124
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0159608
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier11285
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMIDLANDS CHOICE
# 3
Identifier07466
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BC/BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: