Healthcare Provider Details

I. General information

NPI: 1235674334
Provider Name (Legal Business Name): KYLE BRANDYBERRY LIMHP, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N BAILEY AVE
NORTH PLATTE NE
69101-5436
US

IV. Provider business mailing address

110 N BAILEY AVE P.O. BOX 1208
NORTH PLATTE NE
69101-5436
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-0440
  • Fax:
Mailing address:
  • Phone: 308-534-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-1385
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4849
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1796
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1243
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2319
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: