Healthcare Provider Details

I. General information

NPI: 1710523501
Provider Name (Legal Business Name): KYLE CHRISTOPHER PHILLIPS REGISTERED BEHAVIOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14844 W 107TH ST
LENEXA KS
66215-4002
US

IV. Provider business mailing address

14844 W 107TH ST
LENEXA KS
66215-4002
US

V. Phone/Fax

Practice location:
  • Phone: 720-319-7614
  • Fax: 816-777-0626
Mailing address:
  • Phone: 720-319-7614
  • Fax: 720-319-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: