Healthcare Provider Details

I. General information

NPI: 1790155968
Provider Name (Legal Business Name): KYLE DONALD DENNISON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST STE 301
TACOMA WA
98409-7206
US

IV. Provider business mailing address

4301 S PINE ST STE 301
TACOMA WA
98409-7206
US

V. Phone/Fax

Practice location:
  • Phone: 800-287-2680
  • Fax: 253-476-6547
Mailing address:
  • Phone: 800-287-2680
  • Fax: 253-476-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number276359
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY61444148
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: