Healthcare Provider Details

I. General information

NPI: 1396570321
Provider Name (Legal Business Name): KYLER SCOTT RILETT LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 SPRING ARBOR RD
JACKSON MI
49203-3602
US

IV. Provider business mailing address

300 W WASHINGTON AVE STE 50
JACKSON MI
49201-2176
US

V. Phone/Fax

Practice location:
  • Phone: 517-939-9401
  • Fax:
Mailing address:
  • Phone: 517-741-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023897
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: