Healthcare Provider Details

I. General information

NPI: 1275944944
Provider Name (Legal Business Name): KYLE BEWSEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE PSYCHOLOGY SERVICE (116B)
BILOXI MS
39531-2410
US

IV. Provider business mailing address

400 VETERANS AVE PSYCHOLOGY SERVICE (116B)
BILOXI MS
39531-2410
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5750
  • Fax:
Mailing address:
  • Phone: 228-523-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1892
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: