=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235520248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBINSON-KYLES COUNSELING AND TESTING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2015
-----------------------------------------------------
Last Update Date | 02/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 MARTIN L KING JR AVE STE 1
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33815-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-614-3232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 MARTIN L KING JR AVE STE 1
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33815-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. JEANENE ROBINSON-KYLES
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 863-614-3232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PY8015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------