Healthcare Provider Details

I. General information

NPI: 1861021396
Provider Name (Legal Business Name): KYLE LEE STILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 UNION AVE SE STE 200
OLYMPIA WA
98501-2060
US

IV. Provider business mailing address

1104 12TH ST
BELLINGHAM WA
98225-6650
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 360-927-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO.OP.70054800
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: