Healthcare Provider Details

I. General information

NPI: 1467818641
Provider Name (Legal Business Name): KYLE R STEPHENSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 VICTORY PARKWAY ELET HALL, RM 201
CINCINNATI OH
45207
US

IV. Provider business mailing address

3800 VICTORY PKWY
CINCINNATI OH
45207-1035
US

V. Phone/Fax

Practice location:
  • Phone: 513-745-3463
  • Fax:
Mailing address:
  • Phone: 513-745-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08315
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number22426
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: