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General NPI Number Information
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NPI Number | 1932567211
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Entity Type | Individual
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Provider Name | WADE A KYLE D.MIN,M-RAS
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Gender | Male
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 9774 HAWTHORNE DR.
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730
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Country | US
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Telephone | 888-235-3770
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Fax | 909-237-0703
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Provider Business Mailing Address
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Address Line | 6685 KAISER AVE
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City | FONTANA
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State | CA
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Zip | 92336
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Country | US
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Telephone | 888-235-3770
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Fax | 909-237-0703
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | CA
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