Healthcare Provider Details

I. General information

NPI: 1962775213
Provider Name (Legal Business Name): KYLIE J LIDDLE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 2ND ST
MADISON IN
47250-3419
US

IV. Provider business mailing address

1451 E WEHNER DR
MADISON IN
47250-8601
US

V. Phone/Fax

Practice location:
  • Phone: 812-221-1097
  • Fax: 812-321-6007
Mailing address:
  • Phone: 239-896-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004731A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: