Healthcare Provider Details

I. General information

NPI: 1891262648
Provider Name (Legal Business Name): KYLE STANLEY WEST CBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WENATCHEE AVE STE A
WENATCHEE WA
98801-6655
US

IV. Provider business mailing address

8019 NE 13TH AVE
VANCOUVER WA
98665-9604
US

V. Phone/Fax

Practice location:
  • Phone: 360-984-3131
  • Fax:
Mailing address:
  • Phone: 360-984-3131
  • Fax: 360-718-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61649765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: