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General NPI Number Information
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NPI Number | 1013791441
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Entity Type | Individual
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Provider Name | KYLE BASTOS MS, LPC
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Gender | Male
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 4119 MONTROSE BLVD STE 500
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City | HOUSTON
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State | TX
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Zip | 77006-4970
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Country | US
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Telephone | 512-956-6463
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Fax | 866-653-5142
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Provider Business Mailing Address
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Address Line | 124 EMERALD CLOUD LN
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City | LEAGUE CITY
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State | TX
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Zip | 77573-0764
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 61886
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 86959
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License Number State | TX
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