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General NPI Number Information
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NPI Number | 1952912834
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Entity Type | Individual
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Provider Name | KYLIE CHAMPA
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 2345 STANFORD CT STE 602
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City | NAPLES
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State | FL
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Zip | 34112-4841
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Country | US
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Telephone | 561-806-1087
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Fax |
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Provider Business Mailing Address
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Address Line | 9163 CYPRESS DR N
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City | FORT MYERS
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State | FL
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Zip | 33967-5290
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Country | US
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Telephone | 954-495-5614
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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